Healthcare Provider Details

I. General information

NPI: 1740100635
Provider Name (Legal Business Name): HEALING HEARTS SOBER LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 N MOLLISON AVE
EL CAJON CA
92021-3246
US

IV. Provider business mailing address

16202 SCARBERY RD
RAMONA CA
92065-4261
US

V. Phone/Fax

Practice location:
  • Phone: 619-456-1829
  • Fax:
Mailing address:
  • Phone: 619-456-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JAIME JOHANSON
Title or Position: OWNER/CEO
Credential:
Phone: 619-456-1829