Organization
A WAY OUT SOBER LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTHALA MARULASIDDAIAH (OFFICE SUPPORT)
(952) 221-7228
Entity
Organization
Contact information
Practice address
22851 MN HIGHWAY 15, DASSEL, MN 55325-3568
(612) 916-8770
(612) 268-4733
Mailing address
22851 MN HIGHWAY 15, DASSEL, MN 55325-3568
(612) 916-8770
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
02/17/2026
Last updated
02/17/2026
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