MEDICARE: WESTSIDE SOBER LIVING CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	190074BP	CA

General Provider Information

NPI Number	:	1063637890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE SOBER LIVING CENTERS

Provider Business Mailing Address
First Line	:	PO BOX 670549
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-0549
Country	:	US
Telephone Number	:	615-567-7282
Fax Number	:	615-807-2931

Provider Business Practice Location Address
First Line	:	3743 S BARRINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3218
Country	:	US
Telephone Number	:	310-390-2340
Fax Number	:

Authorized Official
Title or Position	:	CPC, CHC, CHPC
Name	:	MRS. CHERYL MAPLESDEN
Credential	:
Telephone Number	:	615-510-3078

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	06/08/2016

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