Healthcare Provider Details

I. General information

NPI: 1780513101
Provider Name (Legal Business Name): CLEAR SKIES RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18722 STRATHERN ST
RESEDA CA
91335-1221
US

IV. Provider business mailing address

7655 WINNETKA AVE UNIT 2344
WINNETKA CA
91396-7020
US

V. Phone/Fax

Practice location:
  • Phone: 818-321-6297
  • Fax:
Mailing address:
  • Phone: 818-321-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE LEE MELVILLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 818-321-6297