Provider Demographics
NPI:1477375673
Name:REDEMPTION SOBER LIVING
Entity type:Organization
Organization Name:REDEMPTION SOBER LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAPOLEON
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:713-545-3723
Mailing Address - Street 1:2719 CHAMBERLAIN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-1603
Mailing Address - Country:US
Mailing Address - Phone:713-545-3723
Mailing Address - Fax:
Practice Address - Street 1:2719 CHAMBERLAIN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-1603
Practice Address - Country:US
Practice Address - Phone:713-545-3723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No252Y00000XAgenciesEarly Intervention Provider Agency