Organization
CLEAN & SOBER DETOX A CALIFORNIA NONPROFIT CORPORATION
Active
Other names
Clean & Sober Detox
Organization subpart
No
Provider details
NPI number
Authorized official
MARYL RUSSO (FACILITIES ADMIN)
(916) 273-4537
Entity
Organization
Contact information
Practice address
8946 MADISON AVE, FAIR OAKS, CA 95628
(916) 965-3386
(916) 536-1393
Mailing address
3 CORBETT WAY, EATONTOWN, NJ 07724-2283
(973) 901-6123
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
340067AN
CA
Other
Enumeration date
12/21/2005
Last updated
08/17/2018
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