Healthcare Provider Details

I. General information

NPI: 1972175065
Provider Name (Legal Business Name): CLEAR RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5481 E SANTA ANA CANYON RD
ANAHEIM CA
92807-3100
US

IV. Provider business mailing address

18119 PRAIRIE AVE
TORRANCE CA
90504-3739
US

V. Phone/Fax

Practice location:
  • Phone: 877-799-1985
  • Fax: 866-899-1638
Mailing address:
  • Phone: 877-799-1985
  • Fax: 866-899-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTHA KOO
Title or Position: CMO
Credential: MD
Phone: 877-799-1985