IMMANUEL SOBRIETY INC. (NPI# 1467096818) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467096818 |
| Entity Type | Organization |
| Organization Name | IMMANUEL SOBRIETY INC. |
| Practice Address |
23265 Park Valley Dr Moreno Valley CA 92553-5963 |
| Mailing Address |
Po Box 10271 Moreno Valley CA 92552-0271 |
| Practice Telephone | 9516533000 |
| Mailing Telephone | 9516533000 |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2019-10-29 |
| Authorized Official Name | MRS. ELIZABETH REID (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9515307680 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 13921 Courage St, Moreno Valley, CA 925538757 | 9516533000 | |
| 13941 Courage St, Moreno Valley, CA 925538757 | 9516533000 |
| Street Address |
23265 PARK VALLEY DR |
| City | MORENO VALLEY |
| State | CA |
| Zip Code | 92553-5963 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104441559 | Tanya Gentle | Marriage & Family Therapist | 2319 Cottonwood Avenue, Building A Suite 110, Moreno Valley, CA 92553 | 2020-06-11 |
| 1275194227 | Antonio Pearce | Psychologist | 12968 Frederick Street, Suite D, Moreno Valley, CA 92553 | 2019-06-20 |
| 1346726486 | Elias Y. Rached | Chiropractor | 23846 Sunnymead Blvd Ste 4, Moreno Valley, CA 92553 | 2018-07-12 |
| 1952813420 | Shanaya Frederick | Driver | 14929 Spinnaker Lane, Moreno Valley, CA 92553 | 2017-10-24 |
| 1457879413 | R & C Logistic Services, LLC | Private Vehicle | 14768 Briana St, Moreno Valley, CA 92553 | 2017-08-30 |
| 1720505084 | Elda Pricila Hernandez | Behavioral Analyst | 24596 Atwood Ave.apt1, Moreno Valley, CA 92553 | 2017-08-28 |
| 1174044101 | Ps Medical Supplies Inc | Durable Medical Equipment & Medical Supplies | 24594 Sunnymead Blvd, Suite M, Moreno Valley, CA 92553 | 2017-06-29 |
| 1942736327 | Richard Pantoja Reyna | Licensed Vocational Nurse | 23119 Cottonwood Ave Bld A Suite 110, Moreno Valley, CA 92553 | 2017-05-04 |
| 1255872719 | Sibonisiwe Moyo Johnson | Nurse Practitioner | 22555 Alessandro Blvd Ste B, Moreno Valley, CA 92553 | 2017-03-16 |
| 1518311190 | Ryan Macavinta | Nurse Practitioner | 22765 Alessandro Blvd., Moreno Valley, CA 92553 | 2016-04-20 |
| Find all providers in zip 92553 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114549144 | Providence Recovery Centers, Inc. | Substance Abuse Rehabilitation Facility | 11165 Bonnie View Ave, Moreno Valley, CA 92555 | 2020-05-13 |
| 1255823753 | Vital Treatment and Recovery Centers, Inc | Substance Abuse Rehabilitation Facility | 10467 Morning Ridge Dr, Moreno Valley, CA 92557-3211 | 2018-05-31 |
| 1639483274 | Sunrise Alcohol & Drugs Rehab Center | Substance Abuse Rehabilitation Facility | 12125 Day St Ste E315, Moreno Valley, CA 92557-6735 | 2010-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
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| 1801497359 | California Care Detox & Treatment | Substance Abuse Rehabilitation Facility | 25542 Dana Mesa Dr, San Juan Capistrano, CA 92675-4311 | 2020-11-02 |
| 1952900797 | A Sacred Path | Substance Abuse Rehabilitation Facility | 5671 Spanish Flat Rd, Garden Valley, CA 95633 | 2020-10-22 |
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| 1962009845 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 9952 Grandview Dr, La Mesa, CA 91941-6874 | 2020-10-05 |
| 1376140384 | Magic House Recovery Inc | Substance Abuse Rehabilitation Facility | 1001 S Mountvale Ct, Anaheim, CA 92808-2108 | 2020-10-02 |
| 1942807060 | New Perceptions North, LLC | Substance Abuse Rehabilitation Facility | 5084 N Fruit Ave Ste 105, Fresno, CA 93711-3000 | 2020-10-01 |
| 1346857679 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 3480 Hidden Trail Dr, Jamul, CA 91935-2104 | 2020-09-30 |
| 1992312227 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 2810 Camino Del Rio S Ste 106, San Diego, CA 92108-3819 | 2020-09-30 |
| Find all providers with the same taxonomy | ||||
| City | MORENO VALLEY |
| Zip Code | 92553 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.