Provider Demographics
NPI:1669281275
Name:HEALTHY SOBER LIVING CARE LLC
Entity type:Organization
Organization Name:HEALTHY SOBER LIVING CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANIRIHO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-770-2231
Mailing Address - Street 1:2081 NW 81ST ST
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-5634
Mailing Address - Country:US
Mailing Address - Phone:515-770-2231
Mailing Address - Fax:
Practice Address - Street 1:2081 NW 81ST ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-5634
Practice Address - Country:US
Practice Address - Phone:515-770-2231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)