MEDICARE: LAST STOP RECOVERY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1245916535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAST STOP RECOVERY INC.

Provider Business Mailing Address
First Line	:	11632 STAGG ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-2638
Country	:	US
Telephone Number	:	818-697-2736
Fax Number	:

Provider Business Practice Location Address
First Line	:	11632 STAGG ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-2638
Country	:	US
Telephone Number	:	818-697-2736
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PATRICK WILLIAM MORRIS
Credential	:
Telephone Number	:	818-697-2736

Provider Enumeration Date	:	06/22/2023
Last Update Date	:	06/22/2023

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