Provider Demographics
NPI:1629545678
Name:CREATE HOPE RECOVERY
Entity Type:Organization
Organization Name:CREATE HOPE RECOVERY
Other - Org Name:SUBLIME WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIESING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-342-0265
Mailing Address - Street 1:2414 S FAIRVIEW ST STE 215
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5318
Mailing Address - Country:US
Mailing Address - Phone:888-235-8353
Mailing Address - Fax:
Practice Address - Street 1:1231 W SAINT GERTRUDE PL
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3132
Practice Address - Country:US
Practice Address - Phone:714-587-4193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURF CITY SOLUTIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-29
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder