Healthcare Provider Details

I. General information

NPI: 1073475117
Provider Name (Legal Business Name): REPRIEVE HOLDINGS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24860 OLIVE TREE LN
LOS ALTOS HILLS CA
94024-6427
US

IV. Provider business mailing address

24860 OLIVE TREE LN
LOS ALTOS HILLS CA
94024-6427
US

V. Phone/Fax

Practice location:
  • Phone: 415-717-3413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN FREED
Title or Position: OWNER / CEO
Credential:
Phone: 415-717-3413