Organization
WEST SIDE SOBER LIVING
Active
Other names
DBA One Twelve
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CLIFTON HOLMES (OWNER)
(952) 513-7475
Entity
Organization
Contact information
Practice address
12218 LAKE STREET EXT, MINNETONKA, MN 55305-5172
(952) 513-7475
Mailing address
12218 LAKE STREET EXT, MINNETONKA, MN 55305-5172
(952) 513-7475
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
1066522
MN
Other
Enumeration date
02/18/2014
Last updated
02/18/2014
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