WEST SIDE SOBER LIVING NPI 1366866907

NPI Information

WEST SIDE SOBER LIVING is a substance abuse rehabilitation facility in Minnetonka, MN. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. WEST SIDE SOBER LIVING NPI is 1366866907. The provider is registered as an organization entity type.
The provider Is Doing Business As Dba One Twelve.

The provider's business location address is:

12218 LAKE STREET EXT
MINNETONKA, MN
ZIP 55305-172
Phone: (952) 513-7475

The provider's authorized official is Michael Clifton Holmes .
The authorized official title is Owner and has the following contact phone number (952) 513-7475.

The enumeration date for this NPI number is 2/18/2014 and was last updated on 2/18/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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