Healthcare Provider Details

I. General information

NPI: 1316648496
Provider Name (Legal Business Name): CLEAN PATH RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W SANTA ANA BLVD
SANTA ANA CA
92703-3835
US

IV. Provider business mailing address

PO BOX 3211
NEWPORT BEACH CA
92659-0855
US

V. Phone/Fax

Practice location:
  • Phone: 949-278-1915
  • Fax:
Mailing address:
  • Phone: 949-278-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: LEE HEILIGMAN
Title or Position: CEO
Credential:
Phone: 949-278-1915