Provider Demographics
NPI:1255948584
Name:SOBER LIVING CONNECTION
Entity type:Organization
Organization Name:SOBER LIVING CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:KASCMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-529-8849
Mailing Address - Street 1:11115 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305
Mailing Address - Country:US
Mailing Address - Phone:952-529-8849
Mailing Address - Fax:952-426-3266
Practice Address - Street 1:11115 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55305
Practice Address - Country:US
Practice Address - Phone:952-529-8849
Practice Address - Fax:952-426-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility