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General NPI Number Information
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NPI Number | 1528227840
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Entity Type | Organization
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Legal Business Name | CLEAN & SOBER RECOVERY SERVICES INC.
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 5820 CHESTNUT AVE
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City | ORANGEVALE
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State | CA
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Zip | 95662-4807
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Country | US
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Telephone | 916-990-0190
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Fax | 916-990-0193
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Provider Business Mailing Address
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Address Line | 5820 CHESTNUT AVE
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City | ORANGEVALE
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State | CA
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Zip | 95662-4807
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Country | US
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Telephone | 916-990-0190
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Fax | 916-990-0193
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN DAVID PERRY
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Credential | CADC-CAS
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Telephone | 916-990-0190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 340093AP
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License Number State | CA
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