Healthcare Provider Details

I. General information

NPI: 1669923124
Provider Name (Legal Business Name): WESTSIDE SOBER LIVING CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20786 COOL OAK WAY
MALIBU CA
90265-5318
US

IV. Provider business mailing address

PO BOX 670549
DALLAS TX
75267-0549
US

V. Phone/Fax

Practice location:
  • Phone: 424-235-2337
  • Fax: 310-943-0438
Mailing address:
  • Phone: 615-567-7282
  • Fax: 615-261-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number198601437
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number197608528
License Number StateCA

VIII. Authorized Official

Name: MRS. CHERYL MAPLESDEN
Title or Position: SR DIRECTOR RCM
Credential: CPC, CHC, CHPC
Phone: 615-510-3708