Provider Demographics
NPI:1700585015
Name:CREATE HOPE RECOVERY
Entity Type:Organization
Organization Name:CREATE HOPE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIESING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-300-1657
Mailing Address - Street 1:2414 S FAIRVIEW ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5344
Mailing Address - Country:US
Mailing Address - Phone:949-300-1657
Mailing Address - Fax:
Practice Address - Street 1:2414 S FAIRVIEW ST STE 201
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5344
Practice Address - Country:US
Practice Address - Phone:949-300-1657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility