Sacred Space Healing & Retreat Center International, Inc.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

490039AP Issued in CA

Legal business name

SACRED SPACE HEALING & RETREAT CENTER INTERNATIONAL, INC.

Practice address

627 Cherry Creek Rd.
Box 311
Cloverdale, CA 95425

Phone

(707) 894-0063

NPI assigned

Sep 21, 2016

Organization subpart

No

Name

Mr. Anusha Amen-Ra, C.N.C.

Title

Ceo / President

Phone

(707) 894-0063

• Sacred Space Retreats Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 21, 2016.

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1043768807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 CHERRY CREEK RD.",
            "address_2": "BOX 311",
            "city": "CLOVERDALE",
            "state": "CA",
            "postal_code": "95425",
            "telephone_number": "707-894-0063",
            "fax_number": "800-914-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 CHERRY CREEK RD.",
            "address_2": "BOX 311",
            "city": "CLOVERDALE",
            "state": "CA",
            "postal_code": "95425",
            "telephone_number": "707-894-0063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED SPACE HEALING & RETREAT CENTER INTERNATIONAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-21",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "AMEN-RA",
        "authorized_official_first_name": "ANUSHA",
        "authorized_official_title_or_position": "CEO / PRESIDENT",
        "authorized_official_telephone_number": "707-894-0063",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.N.C."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "490039AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sacred Space Retreats",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donna Raschke, PH.D.
• Andrea Rigby
• Eileen Denise Roberts, PHD
• Maria Rebecca Ruiz, PPS
• Robert Carver Rutherford, MD
• Saira Joanna Sanchez
• Ronald D Schuster, DC
• Rowena Daniell Sparks
• Sharon Kay Stevens, PPS
• Gloria Patricia Stewart, M.S.CCC SLP

• All providers in Cloverdale, CA
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.