Provider Demographics
NPI:1366173254
Name:JONIK SOBER LIVING LLC
Entity type:Organization
Organization Name:JONIK SOBER LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NKIRUKA
Authorized Official - Middle Name:MIRIAM
Authorized Official - Last Name:POLLYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-519-4138
Mailing Address - Street 1:7852 E BILLINGS ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-7548
Mailing Address - Country:US
Mailing Address - Phone:480-519-4138
Mailing Address - Fax:
Practice Address - Street 1:7852 E BILLINGS ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-7548
Practice Address - Country:US
Practice Address - Phone:480-519-4138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health