Healthcare Provider Details

I. General information

NPI: 1063637890
Provider Name (Legal Business Name): WESTSIDE SOBER LIVING CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3743 S BARRINGTON AVE
LOS ANGELES CA
90066-3218
US

IV. Provider business mailing address

PO BOX 670549
DALLAS TX
75267-0549
US

V. Phone/Fax

Practice location:
  • Phone: 310-390-2340
  • Fax:
Mailing address:
  • Phone: 615-567-7282
  • Fax: 615-807-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190074BP
License Number StateCA

VIII. Authorized Official

Name: MRS. CHERYL MAPLESDEN
Title or Position: CPC, CHC, CHPC
Credential:
Phone: 615-510-3078