Healthcare Provider Details

I. General information

NPI: 1467200253
Provider Name (Legal Business Name): CLEAN PATH RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11651 JERRY LN
GARDEN GROVE CA
92840-3515
US

IV. Provider business mailing address

PO BOX 3211
NEWPORT BEACH CA
92659-0855
US

V. Phone/Fax

Practice location:
  • Phone: 949-734-7432
  • Fax:
Mailing address:
  • Phone: 949-278-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: LEE HEILIGMAN
Title or Position: CEO
Credential:
Phone: 949-278-1915