Healthcare Provider Details

I. General information

NPI: 1023954856
Provider Name (Legal Business Name): RESILIENT RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 SUBURBIA AVE
SANTA CRUZ CA
95062-1250
US

IV. Provider business mailing address

174 SUBURBIA AVE
SANTA CRUZ CA
95062-1250
US

V. Phone/Fax

Practice location:
  • Phone: 831-295-8410
  • Fax:
Mailing address:
  • Phone: 831-295-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: LAURIE S SANFORD
Title or Position: OWNER/ CERTIFIED ADDICTION COUNSELO
Credential: B0000290719
Phone: 831-295-8410