Provider Demographics
NPI:1306249990
Name:POSITIVE SOBRIETY INSTITUTE, LLC
Entity type:Organization
Organization Name:POSITIVE SOBRIETY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:TYEAST
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-813-0428
Mailing Address - Street 1:2300 WINDY RIDGE PARKWAY
Mailing Address - Street 2:SUITE 210S
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:470-440-1647
Mailing Address - Fax:312-642-7055
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-642-7230
Practice Address - Fax:312-642-7055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERMEND HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-26
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 103TA0400X, 103TB0200X, 103TP2701X, 106H00000X
ILA-8526-001-A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty