Provider Demographics
NPI:1528227840
Name:CLEAN & SOBER RECOVERY SERVICES INC.
Entity Type:Organization
Organization Name:CLEAN & SOBER RECOVERY SERVICES INC.
Other - Org Name:CLEAN & SOBER RECOVERY HOME INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-CAS
Authorized Official - Phone:916-990-0190
Mailing Address - Street 1:5820 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4807
Mailing Address - Country:US
Mailing Address - Phone:916-990-0190
Mailing Address - Fax:916-990-0193
Practice Address - Street 1:5820 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4807
Practice Address - Country:US
Practice Address - Phone:916-990-0190
Practice Address - Fax:916-990-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340093AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility