Provider Demographics
NPI:1497446181
Name:TRADE SOBER LIVING
Entity Type:Organization
Organization Name:TRADE SOBER LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:SUDRC
Authorized Official - Phone:209-291-1889
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0543
Mailing Address - Country:US
Mailing Address - Phone:209-742-5095
Mailing Address - Fax:
Practice Address - Street 1:3991 SILVER BAR RD
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9451
Practice Address - Country:US
Practice Address - Phone:209-742-5095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIVE SOLUTIONS FAMILY GUIDANCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty