NPIMap

Organization Active NPI

B. Riley Sober House

  • Addiction (Substance Use Disorder) Counselor
  • Cleveland, OH
National Provider Identifier
1417625666
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
B. RILEY SOBER HOUSE
Practice address
2121 W 117TH St
Cleveland, OH 44111-1642
Phone
(216) 417-4831
NPI assigned
Sep 2, 2021
Last updated
May 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Authorized official

Name
Mr. Rafael Antonio CorreaNPI 1154835007
Title
Founder
Phone
(216) 417-4831

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU Primary
Peer Specialist 175T00000X NU

Addresses

Primary practice location

2121 W 117TH St
Cleveland, OH 44111-1642

Mailing address

2121 W 117TH St
Cleveland, OH 44111-1642
Phone (216) 417-4831

Other identifiers 1

IdentifierTypeStateIssuer
0454981MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230501001904 OH Part B Supplier - Clinic/Group Practice 3870958671 Practice locations: Cleveland, OH

National Provider Directory

National Provider Directory

Locations

3801 Denison Ave
Cleveland, OH 44109

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1417625666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 W 117TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441111642",
            "telephone_number": "216-417-4831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 W 117TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441111642",
            "telephone_number": "216-417-4831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B. RILEY SOBER HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-02",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "CORREA",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_middle_name": "ANTONIO",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "216-417-4831",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0454981",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.