Provider Demographics
NPI:1265314157
Name:SOZO RECOVERY RESIDENCE
Entity type:Organization
Organization Name:SOZO RECOVERY RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MARQUECHO SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-836-1253
Mailing Address - Street 1:2768 N. GENEVIEVE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405
Mailing Address - Country:US
Mailing Address - Phone:951-836-1253
Mailing Address - Fax:
Practice Address - Street 1:2768 N. GENEVIEVE ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3516
Practice Address - Country:US
Practice Address - Phone:951-835-1253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No251E00000XAgenciesHome Health
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodging