Organization
WEST SIDE SOBER LIVING
Active
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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