Healthcare Provider Details

I. General information

NPI: 1487588596
Provider Name (Legal Business Name): WELCOME HOME SOBER LIVING FOR WOMEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 E 16TH ST
NATIONAL CITY CA
91950-3735
US

IV. Provider business mailing address

1517 MADISON AVE
SAN DIEGO CA
92116-1146
US

V. Phone/Fax

Practice location:
  • Phone: 619-879-8484
  • Fax:
Mailing address:
  • Phone: 619-879-8484
  • 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: MR. JUAN F MICHEL
Title or Position: OWNER OPERATOR
Credential:
Phone: 619-879-8484