Organization
EMBODIED RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL NOLAN CADC-II (PRESIDENT, COO)
(408) 705-4598
Entity
Organization
Contact information
Practice address
20 S SANTA CRUZ AVE STE 319, LOS GATOS, CA 95030-6834
(888) 372-3610
Mailing address
20 S SANTA CRUZ AVE STE 319, LOS GATOS, CA 95030-6834
(888) 372-3610
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
97049
BBS
CA
01
—
A011980315
CCAPP
CA
Enumeration date
03/10/2019
Last updated
08/26/2020
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