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General NPI Number Information
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NPI Number | 1346827409
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Entity Type | Organization
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Legal Business Name | LIFE HOUSE RECOVERY HOMES, INC.
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 22280 MAIN ST
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City | HAYWARD
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State | CA
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Zip | 94541-4005
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Country | US
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Telephone | 510-999-7901
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Fax | 510-315-1231
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Provider Business Mailing Address
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Address Line | 22280 MAIN ST
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City | HAYWARD
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State | CA
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Zip | 94541-4005
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Country | US
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Telephone | 510-999-7901
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Fax | 510-315-1231
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. TARA NICOLE WHITAKER
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Credential |
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Telephone | 510-999-7901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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