Healthcare Provider Details

I. General information

NPI: 1962207316
Provider Name (Legal Business Name): SET FREE SANGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ACADEMY AVE
SANGER CA
93657-2422
US

IV. Provider business mailing address

2716 HOLT AVE
SANGER CA
93657-4249
US

V. Phone/Fax

Practice location:
  • Phone: 559-399-3835
  • Fax:
Mailing address:
  • Phone: 559-399-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACOB ZAILIAN
Title or Position: CEO
Credential:
Phone: 559-304-1883