CLEAN & SOBER DETOX A CALIFORNIA NONPROFIT CORPORATION (NPI# 1255317145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255317145 |
| Entity Type | Organization |
| Organization Name | CLEAN & SOBER DETOX A CALIFORNIA NONPROFIT CORPORATION |
| Other Organization Name | CLEAN & SOBER DETOX |
| Practice Address |
8946 Madison Ave Fair Oaks CA 95628 |
| Mailing Address |
3 Corbett Way Eatontown NJ 07724-2283 |
| Practice Telephone | 9169653386 |
| Practice Fax Number | 9165361393 |
| Mailing Telephone | 9739016123 |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2018-08-17 |
| Authorized Official Name | MARYL RUSSO (FACILITIES ADMIN) |
| Authorized Official Telephone | 9162734537 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 340067AN | CA | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Clean & Sober Detox | Doing Business As Name - Organization |
| Street Address |
8946 MADISON AVE |
| City | FAIR OAKS |
| State | CA |
| Zip Code | 95628 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144843889 | Bethany Bryant | Counselor | 8946 Madison Ave, Fair Oaks, CA 95628-4010 | 2020-05-28 |
| 1023631025 | Stuart J Perkins | Counselor | 8946 Madison Ave, Fair Oaks, CA 95628-4010 | 2020-05-26 |
| 1790308799 | Lisa Iwanyczko | Licensed Vocational Nurse | 8946 Madison Ave, Fair Oaks, CA 95628-4010 | 2020-05-26 |
| 1013530005 | Lisa Keeley | Licensed Vocational Nurse | 8946 Madison Ave, Fair Oaks, CA 95628-4010 | 2020-05-25 |
| 1982844171 | Bunny Brown Lindsay | Counselor | 8946 Madison Ave, Fair Oaks, CA 95628-4010 | 2009-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184103590 | Nora's Home Care, Inc | Assisted Living Facility | 5813 Kenneth Ave, Fair Oaks, CA 95628 | 2018-08-08 |
| 1124545512 | Shelby Matthews | Behavior Technician | 7712 Magnolia Ave, Fair Oaks, CA 95628 | 2017-08-25 |
| 1386166908 | Harcourt Bridges, LLC | Counselor | 4112 Crestline Ave Ste. B, Fair Oaks, CA 95628 | 2017-07-14 |
| 1063934867 | Harcourt Bridges, LLC | Counselor | 4112 Crestline Ave Ste. A, Fair Oaks, CA 95628 | 2017-07-13 |
| 1467986075 | Shelby Bryeans | Behavior Technician | 7949 California Ave Ste 15, Fair Oaks, CA 95628 | 2017-04-20 |
| 1942698790 | Life Span Home, Inc | Home Health | 4041 Bridge Street, Fair Oaks, CA 95628 | 2015-01-02 |
| 1861808008 | Edward John Olson | Social Worker | 5213 Vista Del Oro Way, Fair Oaks, CA 95628 | 2014-07-09 |
| 1073924643 | Frank Gontarski | Dentist | 4363 Hazel Avenue, Suite 6, Fair Oaks, CA 95628 | 2014-05-16 |
| 1801232921 | Lisa Hitomi | Community Health Worker | 9915 Fair Oaks Blvd, Fair Oaks, CA 95628 | 2013-05-15 |
| 1972842375 | Nicole Diana Cable | Marriage & Family Therapist | 10217 Fair Oaks Blvd, Suite A, Fair Oaks, CA 95628 | 2013-02-05 |
| Find all providers in zip 95628 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992339451 | Cdt Service Corporation | Substance Abuse Rehabilitation Facility | 8078 Orange Ave, Fair Oaks, CA 95628-5941 | 2020-02-24 |
| 1205497500 | Akua Behavioral Health, Inc | Substance Abuse Rehabilitation Facility | 8086 Orange Ave, Fair Oaks, CA 95628-5941 | 2019-06-26 |
| 1225256902 | Center Point, Inc | Substance Abuse Rehabilitation Facility | 11228 Fair Oaks Blvd, Fair Oaks, CA 95628-5139 | 2007-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801497359 | California Care Detox & Treatment | Substance Abuse Rehabilitation Facility | 25542 Dana Mesa Dr, San Juan Capistrano, CA 92675-4311 | 2020-11-02 |
| 1952900797 | A Sacred Path | Substance Abuse Rehabilitation Facility | 5671 Spanish Flat Rd, Garden Valley, CA 95633 | 2020-10-22 |
| 1467051672 | Spearhead Health Centers, LLC. | Substance Abuse Rehabilitation Facility | 11704 Wilshire Blvd Ste 226, Los Angeles, CA 90025-1504 | 2020-10-19 |
| 1073111613 | A Place To Heal | Substance Abuse Rehabilitation Facility | 14540 Hamlin St Ste H, Van Nuys, CA 91411-4153 | 2020-10-15 |
| 1871191569 | Old Oak Ranch Recovery Center | Substance Abuse Rehabilitation Facility | 19401 Susan Way, Sonora, CA 95370-9266 | 2020-10-14 |
| 1962009845 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 9952 Grandview Dr, La Mesa, CA 91941-6874 | 2020-10-05 |
| 1376140384 | Magic House Recovery Inc | Substance Abuse Rehabilitation Facility | 1001 S Mountvale Ct, Anaheim, CA 92808-2108 | 2020-10-02 |
| 1942807060 | New Perceptions North, LLC | Substance Abuse Rehabilitation Facility | 5084 N Fruit Ave Ste 105, Fresno, CA 93711-3000 | 2020-10-01 |
| 1346857679 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 3480 Hidden Trail Dr, Jamul, CA 91935-2104 | 2020-09-30 |
| 1992312227 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 2810 Camino Del Rio S Ste 106, San Diego, CA 92108-3819 | 2020-09-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.