Healthcare Provider Details

I. General information

NPI: 1801763214
Provider Name (Legal Business Name): ACTIVE CHANGE RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 E WEBER AVE STE 103
STOCKTON CA
95202-2751
US

IV. Provider business mailing address

1738 BARTLETT CT
STOCKTON CA
95206-6358
US

V. Phone/Fax

Practice location:
  • Phone: 209-921-0971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARTIN SISNEROZ
Title or Position: CEO
Credential:
Phone: 209-921-0971