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General NPI Number Information
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NPI Number | 1154889079
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Entity Type | Organization
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Legal Business Name | EMBODIED RECOVERY, LLC
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Dates
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Enumeration Date | 03/10/2019
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 20 S SANTA CRUZ AVE STE 319
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City | LOS GATOS
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State | CA
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Zip | 95030-6834
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Country | US
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Telephone | 888-372-3610
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Fax |
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Provider Business Mailing Address
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Address Line | 20 S SANTA CRUZ AVE STE 319
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City | LOS GATOS
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State | CA
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Zip | 95030-6834
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Country | US
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Telephone | 888-372-3610
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, COO
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Name | MICHAEL NOLAN
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Credential | CADC-II
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Telephone | 408-705-4598
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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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