Sober Living in Madison, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

SOBER LIVING IN MADISON, LLC

Practice address

2101 N Sherman Ave
Madison, WI 53704-3932

Phone

(608) 520-7142

NPI assigned

Oct 13, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mirzo Khasimov

Title

President

Phone

(608) 520-7142

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Latisha Landing

  • Addiction (Substance Use Disorder) Counselor
  • Madison, WI
  • NPI 1598154833
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665705600000",
    "number": "1013633882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 N SHERMAN AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537043932",
            "telephone_number": "608-520-7142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 N SHERMAN AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537043932",
            "telephone_number": "608-520-7142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOBER LIVING IN MADISON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-13",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A",
        "authorized_official_last_name": "KHASIMOV",
        "authorized_official_first_name": "MIRZO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "608-520-7142"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea C So, OD
• Bophia So
• Soar Case Management Services, Inc.
• Gregory J Sobczak, DDS
• Janelle Sobecki, MD
• Carly G Sobol
• Kara Socha, RBT
• Socorro Home Health Care Inc
• Sarah Soderberg, MD, MPH
• Kristan M. Sodergren, APNP

• Substance Use Disorder Rehabilitation Clinic/Center in Madison, WI
• Providers in Madison, WI by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.