Provider Demographics
NPI:1659062115
Name:SOBRIUS AT BASSETT
Entity Type:Organization
Organization Name:SOBRIUS AT BASSETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, SOBRIUS
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:FULLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-329-6687
Mailing Address - Street 1:506 CLIFFVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-5084
Mailing Address - Country:US
Mailing Address - Phone:276-601-2736
Mailing Address - Fax:
Practice Address - Street 1:9850 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BASSETT
Practice Address - State:VA
Practice Address - Zip Code:24055-5909
Practice Address - Country:US
Practice Address - Phone:276-336-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility