Sober Living in Madison, LLC

NPI #1013633882 in Madison, Wisconsin

Provider Information

NPI Number: 1013633882
Entity Type: Organization
Organization Name: Sober Living in Madison, LLC
Primary Specialty: Clinic/Center - Rehabilitation, Substance Use Disorder
Enumeration Date: Oct 13, 2022
Last Updated: Oct 14, 2022

Practice Location

Address: 2101 N SHERMAN AVE
City: Madison
State: Wisconsin
ZIP Code: 53704-3932
Phone: (608) 520-7142

Authorized Official

Name: MIRZO KHASIMOV
Title: PRESIDENT
Phone: (608) 520-7142

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinical Medical Laboratory	291U00000X
Substance Abuse Rehabilitation Facility	324500000X
Clinic/Center - Rehabilitation, Substance Use Disorder — Rehabilitation, Substance Use Disorder	261QR0405X	Primary

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