MEDICARE: STAIRWAYS RECOVERY HOMES 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	:	1720642804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAIRWAYS RECOVERY HOMES INC

Provider Business Mailing Address
First Line	:	21210 ERWIN ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3714
Country	:	US
Telephone Number	:	818-456-3923
Fax Number	:

Provider Business Practice Location Address
First Line	:	22742 VENTURA BLVD
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1333
Country	:	US
Telephone Number	:	949-307-0585
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRAVIS GRANT
Credential	:
Telephone Number	:	949-307-0585

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	05/01/2024

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