Provider Demographics
NPI:1164113551
Name:CLEAN START RECOVERY INC
Entity Type:Organization
Organization Name:CLEAN START RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFARRAH
Authorized Official - Middle Name:EMMA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-488-7046
Mailing Address - Street 1:8862 GARDEN GROVE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1293
Mailing Address - Country:US
Mailing Address - Phone:714-477-0113
Mailing Address - Fax:
Practice Address - Street 1:4701 LOS PATOS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4320
Practice Address - Country:US
Practice Address - Phone:714-477-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility