MEDICARE: SACRED JOURNEY RECOVERY SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1053114892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED JOURNEY RECOVERY SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	161 THUNDER DR STE 214
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-6016
Country	:	US
Telephone Number	:	801-318-4268
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 THUNDER DR STE 214
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-6016
Country	:	US
Telephone Number	:	760-888-5202
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. ANDREW JOHN ANAGNOSTOU
Credential	:
Telephone Number	:	801-318-4268

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/06/2026

Similar Medicare Providers

1487643698 — MELISSA E. HURD M.D.
Practice Location Address:

161 THUNDER DR , STE 103
VISTA, CA
92083-6016

Practice Phone: 760-758-1988
Practice Fax: 760-758-0922

1093795577 — MED MATRIX PHARMACY, INC
Practice Location Address:

161 THUNDER DR
VISTA, CA
92083-6016

Practice Phone: 760-758-7650
Practice Fax: 760-758-8228

1205925989 — ASBAC PHARMACY INC
Practice Location Address:

161 THUNDER DR , SUITE 100
VISTA, CA
92083-6016

Practice Phone: 760-758-7650
Practice Fax: 760-758-8228

1437293446 — EDWARD BARTON EVANS M.D.
Practice Location Address:

161 THUNDER DR , SUITE 104
VISTA, CA
92083-6016

Practice Phone: 760-941-6664
Practice Fax: 760-941-3257

1750417564 — DR. MARIE CHRISTINE LYSTER M.D.
Practice Location Address:

161 THUNDER DR , SUITE 203
VISTA, CA
92083-6016

Practice Phone: 760-414-1567
Practice Fax: 760-414-1771

1467583674 — DR. TENETTE TREVINO D.D.S.
Practice Location Address:

161 THUNDER DR , SUITE 211
VISTA, CA
92083-6016

Practice Phone: 760-631-0454
Practice Fax: 760-631-0539

Directions to “SACRED JOURNEY RECOVERY SOLUTIONS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.