Sober Nation LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

FM1575692 Issued in OH

Legal business name

SOBER NATION LLC

Practice address

226 Wonderly Ave
Oakwood, OH 45419-1755

Phone

(937) 999-2561

Fax

(937) 221-8242

NPI assigned

Oct 4, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Charles M Misja, M.D.

Title

Medical Doctor/ Owner

Phone

(937) 260-3156

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1164971073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 WONDERLY AVE",
            "city": "OAKWOOD",
            "state": "OH",
            "postal_code": "454191755",
            "telephone_number": "937-999-2561",
            "fax_number": "937-221-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 WONDERLY AVE",
            "city": "OAKWOOD",
            "state": "OH",
            "postal_code": "454191755",
            "telephone_number": "937-999-2561",
            "fax_number": "937-221-8242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOBER NATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-04",
        "last_updated": "2016-10-04",
        "status": "A",
        "authorized_official_last_name": "MISJA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DOCTOR/ OWNER",
        "authorized_official_telephone_number": "937-260-3156",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "OH",
            "license": "FM1575692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0051749",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0117002",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Raymond H See, MD
• Elena Nicole Smith, RDN, LD
• Jeremiah Paul Smith, AU.D.
• Jessica A Smith, PT
• Danielle Nicole Snyder, D.C.
• Ethan M Sullivan, DPT
• Katheryn Rose Talcott, MS, RD, CDE, LD
• Heather Tutt-Robinson, LMT
• Tara Sue Vangundy, CFNP
• Jithin Vijayan, MA, LPCC

• Substance Use Disorder Rehabilitation Clinic/Center in Oakwood, OH
• Providers in Oakwood, OH by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; 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.