Provider Demographics
NPI:1053114892
Name:SACRED JOURNEY RECOVERY SOLUTIONS LLC
Entity type:Organization
Organization Name:SACRED JOURNEY RECOVERY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:SPETTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-357-3211
Mailing Address - Street 1:161 THUNDER DR STE 214
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6016
Mailing Address - Country:US
Mailing Address - Phone:614-357-3211
Mailing Address - Fax:
Practice Address - Street 1:161 THUNDER DR STE 214
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6016
Practice Address - Country:US
Practice Address - Phone:760-888-5202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health