Healthcare Provider Details

I. General information

NPI: 1811169105
Provider Name (Legal Business Name): STAIRWAY TO RECOVERY DRUG AND ALCOHOL REHABILITAITON FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6102 SOUTH BROADWAY
LOS ANGELES CA
90003-1428
US

IV. Provider business mailing address

6102 SOUTH BROADWAY
LOS ANGELES CA
90003-1428
US

V. Phone/Fax

Practice location:
  • Phone: 661-236-7765
  • Fax:
Mailing address:
  • Phone: 323-526-1073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. SHRAWNDA HARRIS
Title or Position: CHIEF EXECUTIVE OFFICE
Credential:
Phone: 661-236-7765