Healthcare Provider Details

I. General information

NPI: 1669228995
Provider Name (Legal Business Name): MINUTE BY MINUTE SOBER HOUSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30015 ROSE BLOSSOM DR
MURRIETA CA
92563-4733
US

IV. Provider business mailing address

16320 STEVENS AVE
LAKE ELSINORE CA
92530-5035
US

V. Phone/Fax

Practice location:
  • Phone: 760-969-9291
  • Fax:
Mailing address:
  • Phone: 760-917-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LEONARD H REDMAN
Title or Position: OWNER
Credential:
Phone: 760-917-2090