Provider Demographics
NPI:1942045273
Name:SELF ACCEPTANCE RECOVERY HOMES
Entity type:Organization
Organization Name:SELF ACCEPTANCE RECOVERY HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-294-9498
Mailing Address - Street 1:1540 UTAH CT
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-9338
Mailing Address - Country:US
Mailing Address - Phone:707-294-9498
Mailing Address - Fax:
Practice Address - Street 1:1115 JACOBS DR
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3252
Practice Address - Country:US
Practice Address - Phone:707-294-9498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility