MEDICARE: CS II,LLC DBA CLEAN AND SOBER DETOX

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1205344876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CS II,LLC DBA CLEAN AND SOBER DETOX

Provider Business Mailing Address
First Line	:	P O BOX 412343
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-0001
Country	:	US
Telephone Number	:	732-210-0509
Fax Number	:	732-542-1948

Provider Business Practice Location Address
First Line	:	8946 MADISON AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95628-4010
Country	:	US
Telephone Number	:	732-210-0509
Fax Number	:	732-542-1948

Authorized Official
Title or Position	:	CONTRACT MANAGER
Name	:	GILBERT YATES
Credential	:
Telephone Number	:	877-262-7803

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	10/01/2024

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