MEDICARE: YELLOWSTONE WOMEN'S FIRST STEP HOUSE, INC.

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

General Provider Information

NPI Number	:	1356632061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YELLOWSTONE WOMEN'S FIRST STEP HOUSE, INC.

Provider Business Mailing Address
First Line	:	154 E BAY ST
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2147
Country	:	US
Telephone Number	:	888-941-9048
Fax Number	:	949-646-5296

Provider Business Practice Location Address
First Line	:	1561 INDUS ST
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1306
Country	:	US
Telephone Number	:	888-941-9048
Fax Number	:	949-646-5296

Authorized Official
Title or Position	:	CONTRACTS NEGOTIATOR/MEDICAL BILLER
Name	:	MS. KATHERINE ROSE CATANZARITE
Credential	:	JURIS DOCTOR
Telephone Number	:	818-773-0989

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	04/28/2011

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