Organization
A SOBER WAY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA TILLMAN (PRESIDENT)
(928) 445-3834
Entity
Organization
Contact information
Practice address
1211 EAST GURLEY STREET, SUITE 2, PRESCOTT, AZ 86301
(928) 445-3834
(928) 445-3649
Mailing address
1211 EAST GURLEY STREET, SUITE 2, PRESCOTT, AZ 86301
(928) 445-3834
(928) 445-3649
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
BH3230
AZ
261QR0800X
Recovery Care Clinic/Center
BH2563
AZ
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
BH3230
AZ
Other
Enumeration date
07/25/2007
Last updated
02/09/2017
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