Clean & Sober Living Corp

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

CLEAN & SOBER LIVING CORP

Practice address

260 Victoria St Apt C1
Costa Mesa, CA 92627-6002

Phone

(949) 836-8779

NPI assigned

Jan 29, 2015

Organization subpart

No

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

Authorized official

Name

Cheryl Gwartney

Title

Cfo

Phone

(949) 278-2843

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1422489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1477943496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23665 BIRTCHER DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301770",
            "telephone_number": "949-278-2843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 VICTORIA ST APT C1",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926276002",
            "telephone_number": "949-836-8779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAN & SOBER LIVING CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-29",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "GWARTNEY",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "949-278-2843"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig Raymond Clark, DC
• Desiree Imani Clark
• Kimberly Irene Clark, MFT
• Konner Steven Clarson
• Claudio M. Carvalho, D.O, a Professional Medical Corporation (Functional Orthopedic Rehabilitation Medicine Associates)
• Clean Path Recovery, LLC (Clean Path Behavioral Health)
• Clean Testing Services
• Clear Choice Helpuhear, Inc.
• Clear Detox Center Inc.
• Carolyn Grace Cledera, LCSW #76937

• Clinical Medical Laboratory in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; 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.