NPIMap

Organization Active NPI

Immanuel Sobriety Inc.

Doing business as Immanuel House

  • Substance Abuse Rehabilitation Facility
  • Corona, CA
National Provider Identifier
1275349375
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
IMMANUEL SOBRIETY INC.
Doing business as
Immanuel House
Practice address
20170 Winton St
Corona, CA 92881-4590
Phone
(951) 200-4504
NPI assigned
Dec 4, 2024
Last updated
Dec 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Authorized official

Name
Elizabeth Reid
Title
Executive Director
Phone
(951) 530-7680

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

20170 Winton St
Corona, CA 92881-4590

Mailing address

PO Box 10271
Moreno Valley, CA 92552-0271
Phone (951) 653-3000

Other names 1

  • Immanuel House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Immanuel House6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1275349375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10271",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925520271",
            "telephone_number": "951-653-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20170 WINTON ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928814590",
            "telephone_number": "951-200-4504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMANUEL SOBRIETY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "REID",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "951-530-7680"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Immanuel House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; 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.