CLEAN & SOBER DETOX – NPI #1255317145
Substance Abuse Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

Health Care Provider Taxonomy Code for Substance Abuse Rehabilitation Facility

CLEAN & SOBER DETOX is a substance abuse rehabilitation facility located in FAIR OAKS, CA. NPPES has assigned the NPI number 1255317145 to CLEAN & SOBER DETOX on December 21, 2005. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “CLEAN & SOBER DETOX” is a dba name, the actual legal business name for this organization is CLEAN & SOBER DETOX A CALIFORNIA NONPROFIT CORPORATION. The primary taxonomy selected by this provider is 324500000X from the Health Care Provider Taxonomy code set, which is classified as Substance Abuse Rehabilitation Facility.

The NPI profile was previously updated about 8 years ago on Aug 17, 2018. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for CLEAN & SOBER DETOX below.

NPI Profile for
CLEAN & SOBER DETOX A CALIFORNIA NONPROFIT CORPORATION

NPI Number
1255317145
Enumeration Date

(more than 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
CLEAN & SOBER DETOX A CALIFORNIA NONPROFIT CORPORATION
Doing Business As (dba): CLEAN & SOBER DETOX
Primary location
8946 MADISON AVE
FAIR OAKS, CA 95628
Phone: (916) 965-3386 Fax: (916) 536-1393
Mailing address
3 CORBETT WAY
EATONTOWN, NJ 07724-2283
Phone: (973) 901-6123 Fax:
Organization Subpart
No
Authorized Official
MARYL RUSSO
FACILITIES ADMIN
Phone: (916) 273-4537
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
324500000X
- Substance Abuse Rehabilitation Facility (Primary)		 CA 340067AN

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.