West Side Sober Living

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

1066522 Issued in MN

Legal business name

WEST SIDE SOBER LIVING

Practice address

12218 Lake Street Ext
Minnetonka, MN 55305-5172

Phone

(952) 513-7475

NPI assigned

Feb 18, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Michael Clifton Holmes

Title

Owner

Phone

(952) 513-7475

Specialties & licenses 1

Addresses

Other names 1

• DBA One Twelve Doing business as

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

{
    "created_epoch": "1392681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392681600000",
    "number": "1366866907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12218 LAKE STREET EXT",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055172",
            "telephone_number": "952-513-7475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12218 LAKE STREET EXT",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055172",
            "telephone_number": "952-513-7475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SIDE SOBER LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-18",
        "last_updated": "2014-02-18",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CLIFTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-513-7475",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "1066522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA One Twelve",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wellness Initiatives, LLC
• Robert Arthur Wengler, M.D.
• Halbert Wenngatz, MD
• West Metro Psychiatry, PC
• West Side Counseling LLC
• Anny West
• Charles Westholm, LICSW
• Michael Ross Wexler, M.D.
• Claire Lynn Wheatley, DPT
• Deborah Anne Whidby, APRN, NP-C

• Substance Abuse Rehabilitation Facility in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Substance Abuse Rehabilitation Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; 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.