Provider Demographics
NPI:1578293791
Name:OPPORTUNITY HOUSE SOBER LIVING
Entity Type:Organization
Organization Name:OPPORTUNITY HOUSE SOBER LIVING
Other - Org Name:OPPORTUNITY HOUSE SOBDER LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:559-907-8528
Mailing Address - Street 1:5365 N MARIPOSA ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6805
Mailing Address - Country:US
Mailing Address - Phone:559-907-8528
Mailing Address - Fax:
Practice Address - Street 1:5365 N MARIPOSA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6805
Practice Address - Country:US
Practice Address - Phone:559-907-8528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-11
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder