Healthcare Provider Details

I. General information

NPI: 1114697125
Provider Name (Legal Business Name): SUBLIME HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CYPRESS AVE
SANTA ANA CA
92707-2847
US

IV. Provider business mailing address

8211 E REGAL PL STE 102
TULSA OK
74133-7181
US

V. Phone/Fax

Practice location:
  • Phone: 800-935-2305
  • Fax: 714-398-8822
Mailing address:
  • Phone: 800-935-2305
  • Fax: 714-398-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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