Healthcare Provider Details

I. General information

NPI: 1134095540
Provider Name (Legal Business Name): SACRAMENTO OUTPATIENT RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 47TH AVE STE 106
SACRAMENTO CA
95824-3923
US

IV. Provider business mailing address

4600 47TH AVE STE 106
SACRAMENTO CA
95824-3923
US

V. Phone/Fax

Practice location:
  • Phone: 916-415-3411
  • Fax: 916-415-3400
Mailing address:
  • Phone: 916-415-3411
  • Fax: 916-415-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TANISHA CARAVEO
Title or Position: MEMBER/CEO
Credential:
Phone: 916-415-3411