Healthcare Provider Details

I. General information

NPI: 1437609773
Provider Name (Legal Business Name): WESTSIDE SOBER LIVING CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 WILSHIRE BLVD
SANTA MONICA CA
90403-4615
US

IV. Provider business mailing address

PO BOX 670549
DALLAS TX
75267-0549
US

V. Phone/Fax

Practice location:
  • Phone: 866-595-3105
  • Fax: 424-272-9303
Mailing address:
  • Phone: 615-567-7282
  • Fax: 615-261-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190625GP
License Number StateCA

VIII. Authorized Official

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