| Embodied Recovery, Llc | |
|
20 S Santa Cruz Ave Ste 319 Los Gatos CA 95030-6834 | |
| (888) 372-3610 | |
| Not Available |
| Full Name | Embodied Recovery, Llc |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 20 S Santa Cruz Ave Ste 319, Los Gatos, California |
| Authorized Official Name and Position | Michael Nolan (PRESIDENT, COO) |
| Authorized Official Contact | 4087054598 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Embodied Recovery, Llc 20 S Santa Cruz Ave Ste 319 Los Gatos CA 95030-6834 Ph: (888) 372-3610 | Embodied Recovery, Llc 20 S Santa Cruz Ave Ste 319 Los Gatos CA 95030-6834 Ph: (888) 372-3610 |
| NPI Number | 1154889079 |
|---|---|
| Provider Enumeration Date | 03/10/2019 |
| Last Update Date | 08/26/2020 |
| Certification Date | 08/26/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154889079 | NPI | - | NPPES |
| A011980315 | Other | CA | CCAPP |
| 97049 | Other | CA | BBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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