NPI 1366866907

West Side Sober Living

Organisation Substance Abuse Rehabilitation Facility Minnetonka, MN

Practice location

Address: 12218 Lake Street Ext, Minnetonka, MN 55305-5172
Phone: (952) 513-7475

Authorised official

Name: Michael Clifton Holmes
Title: Owner
Phone: (952) 513-7475

Registered specialties

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X Licence 1066522 (MN)

Other Substance Abuse Rehabilitation Facility providers in Minnesota →

Registry record

NPI: 1366866907
Entity type: Organization
NPI issued: 18 Feb 2014
Record last updated: 18 Feb 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.