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General NPI Number Information
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NPI Number | 1790228815
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Entity Type | Organization
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Legal Business Name | STEPHOUSE RECOVERY
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 18627 BROOKHURST ST # 401
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6748
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Country | US
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Telephone | 714-933-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 18627 BROOKHURST ST # 401
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6748
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Country | US
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Telephone | 714-933-6652
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GEORGE VILAGUT
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Credential |
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Telephone | 714-394-3494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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