Provider Demographics
NPI:1275134058
Name:SOBRIETY HOUSE, INC.
Entity Type:Organization
Organization Name:SOBRIETY HOUSE, INC.
Other - Org Name:PHOENIX CONCEPT
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:720-259-8865
Mailing Address - Street 1:121 ACOMA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1429
Mailing Address - Country:US
Mailing Address - Phone:720-381-4334
Mailing Address - Fax:
Practice Address - Street 1:2162 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2033
Practice Address - Country:US
Practice Address - Phone:303-800-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOBRIETY HOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-06
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility