Healthcare Provider Details

I. General information

NPI: 1700585015
Provider Name (Legal Business Name): CREATE HOPE RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 05/20/2024
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 S FAIRVIEW ST STE 201
SANTA ANA CA
92704-5344
US

IV. Provider business mailing address

2414 S FAIRVIEW ST STE 201
SANTA ANA CA
92704-5344
US

V. Phone/Fax

Practice location:
  • Phone: 949-300-1657
  • Fax:
Mailing address:
  • Phone: 949-300-1657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PRIESING
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-300-1657