Organization
ACTIVE CHANGE RECOVERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN SISNEROZ JR. (CEO)
(559) 250-1121
Entity
Organization
Contact information
Practice address
229 E WEBER AVE STE 103, STOCKTON, CA 95202-2751
(209) 921-0971
Mailing address
1738 BARTLETT CT, STOCKTON, CA 95206-6358
(559) 250-1121
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
10/18/2023
Last updated
01/13/2026
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