Embodied Recovery, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

EMBODIED RECOVERY, LLC

Practice address

20 S Santa Cruz Ave Ste 319
Los Gatos, CA 95030-6834

Phone

(888) 372-3610

NPI assigned

Mar 10, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Nolan, CADC-IINPI 1881119584

Title

President, Coo

Phone

(408) 705-4598

Specialties & licenses 2

Addresses

Other identifiers 2

Tax ID family

Embodied Recovery LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Embodied Recovery, LLC

  • Adult Mental Health Clinic/Center
  • Los Gatos, CA
  • NPI 1528671161
  NPD tax ID

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Q Nolan, CADC-II

  • Addiction (Substance Use Disorder) Counselor
  • San Jose, CA
  • NPI 1881119584
  NPD Authorized official
• Michael Huynh

  • Marriage & Family Therapist
  • Gilroy, CA
  • NPI 1043023674
  NPD (past)
• Timothy Van Den Berg, RADT

  • Addiction (Substance Use Disorder) Counselor
  • Los Gatos, CA
  • NPI 1407669278
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598400000000",
    "number": "1154889079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 S SANTA CRUZ AVE STE 319",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950306834",
            "telephone_number": "888-372-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 S SANTA CRUZ AVE STE 319",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950306834",
            "telephone_number": "888-372-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBODIED RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-10",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A",
        "authorized_official_last_name": "NOLAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT, COO",
        "authorized_official_telephone_number": "408-705-4598",
        "authorized_official_credential": "CADC-II"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCAPP",
            "identifier": "A011980315",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BBS",
            "identifier": "97049",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• El Gato Medical Clinic for Women, Inc.
• Elementality Wellness
• Carrie Ellis, P.T.
• Edward L Ellsworth, M.D.
• Nadine Emami
• Embodied Recovery, LLC
• John Wesley Emison, M.D., D.D.S.
• Emotional Awareness Institute
• Emq
• Jianyun Huang Engelhardt, L. AC.

• Substance Use Disorder Rehabilitation Clinic/Center in Los Gatos, CA
• Providers in Los Gatos, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; 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.