MEDICARE: CLEAN PATH RECOVERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1184553505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAN PATH RECOVERY

Provider Business Mailing Address
First Line	:	2345 NOTRE DAME RD
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-6441
Country	:	US
Telephone Number	:	949-278-1915
Fax Number	:

Provider Business Practice Location Address
First Line	:	12555 GARDEN GROVE BLVD STE 303&305
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1902
Country	:	US
Telephone Number	:	949-278-1915
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LEE HEILIGMAN
Credential	:
Telephone Number	:	949-278-1915

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/25/2026

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Directions to “CLEAN PATH RECOVERY ” Practice Location

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