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General NPI Number Information
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NPI Number | 1053114892
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Entity Type | Organization
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Legal Business Name | SACRED JOURNEY RECOVERY SOLUTIONS LLC
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 161 THUNDER DR STE 214
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City | VISTA
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State | CA
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Zip | 92083-6016
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Country | US
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Telephone | 760-888-5202
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Fax |
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Provider Business Mailing Address
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Address Line | 161 THUNDER DR STE 214
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City | VISTA
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State | CA
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Zip | 92083-6016
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Country | US
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Telephone | 801-318-4268
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. ANDREW JOHN ANAGNOSTOU
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Credential |
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Telephone | 801-318-4268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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