MEDICARE: CLEAN PATH RECOVERY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	3245S0500X	Children's Substance Abuse Rehabilitation Facility
3	324500000X	Substance Abuse Rehabilitation Facility
4	177F00000X	Lodging Provider

General Provider Information

NPI Number	:	1316648496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAN PATH RECOVERY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3211
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92659-0855
Country	:	US
Telephone Number	:	949-278-1915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1218 W SANTA ANA BLVD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3835
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	:	03/15/2023
Last Update Date	:	02/10/2026

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