Healthcare Provider Details

I. General information

NPI: 1174435218
Provider Name (Legal Business Name): CLEANING BRAINS UP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E 6TH ST
CORONA CA
92879-1732
US

IV. Provider business mailing address

32042 LARGO VISTA RD
LLANO CA
93544
US

V. Phone/Fax

Practice location:
  • Phone: 909-548-2959
  • Fax:
Mailing address:
  • Phone: 909-545-4671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: BARNEY TIMMONS
Title or Position: CEO
Credential:
Phone: 909-545-4671