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General NPI Number Information
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NPI Number | 1801763214
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Entity Type | Organization
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Legal Business Name | ACTIVE CHANGE RECOVERY INC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 229 E WEBER AVE STE 103
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City | STOCKTON
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State | CA
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Zip | 95202-2751
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Country | US
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Telephone | 209-921-0971
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Fax |
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Provider Business Mailing Address
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Address Line | 1738 BARTLETT CT
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City | STOCKTON
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State | CA
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Zip | 95206-6358
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARTIN SISNEROZ
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Credential |
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Telephone | 209-921-0971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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