Clean & Sober Detox a California Nonprofit Corporation

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

340067AN Issued in CA

Legal business name

CLEAN & SOBER DETOX A CALIFORNIA NONPROFIT CORPORATION

Doing business as

Clean & Sober Detox

Practice address

8946 Madison Ave
Fair Oaks, CA 95628

Phone

(916) 965-3386

Fax

(916) 536-1393

NPI assigned

Dec 21, 2005

Organization subpart

No

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

Authorized official

Name

Maryl Russo

Title

Facilities Admin

Phone

(916) 273-4537

Specialties & licenses 1

Addresses

Other names 1

• Clean & Sober Detox Doing business as

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1255317145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 CORBETT WAY",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242283",
            "telephone_number": "973-901-6123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8946 MADISON AVE",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "95628",
            "telephone_number": "916-965-3386",
            "fax_number": "916-536-1393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAN & SOBER DETOX A CALIFORNIA NONPROFIT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-21",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "MARYL",
        "authorized_official_title_or_position": "FACILITIES ADMIN",
        "authorized_official_telephone_number": "916-273-4537"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "340067AN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clean & Sober Detox",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clean & Sober Detox",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ann Susan Cinnamon, LMFT
• Karla Cisneros
• Linda R Clark, MA, CNC
• Melodie M Clark
• Sean Clark, D.P.M.
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• Anya Clowers, RN
• Coalition of Counseling Centers
• Nichole Cobb, LMFT
• Laura Marie Cochran

• Substance Abuse Rehabilitation Facility in Fair Oaks, CA
• Providers in Fair Oaks, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; 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.