Healthcare Provider Details

I. General information

NPI: 1265258669
Provider Name (Legal Business Name): LEMONADE RECOVERY HOMES 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 BUTTE ST
TULARE CA
93274-7858
US

IV. Provider business mailing address

99 ALMADEN BLVD STE 600
SAN JOSE CA
95113-1605
US

V. Phone/Fax

Practice location:
  • Phone: 833-939-6159
  • Fax:
Mailing address:
  • Phone: 833-939-6159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: GRACE KOZ
Title or Position: FOUNDER, CEO
Credential:
Phone: 408-898-8791