Provider Demographics
NPI:1578067625
Name:CLEAN PATH RECOVERY, LLC
Entity Type:Organization
Organization Name:CLEAN PATH RECOVERY, LLC
Other - Org Name:CLEAN PATH BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEILIGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-258-9219
Mailing Address - Street 1:PO BOX 3211
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0855
Mailing Address - Country:US
Mailing Address - Phone:949-734-7432
Mailing Address - Fax:
Practice Address - Street 1:2201 KILSON DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-2918
Practice Address - Country:US
Practice Address - Phone:949-734-7432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility