MEDICARE: STEPHOUSE RECOVERY

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	:	1740723873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHOUSE RECOVERY

Provider Business Mailing Address
First Line	:	7451 WARNER AVE # E-111
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5494
Country	:	US
Telephone Number	:	714-933-6652
Fax Number	:

Provider Business Practice Location Address
First Line	:	7451 WARNER AVE # E-111
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5494
Country	:	US
Telephone Number	:	714-933-6652
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GEORGE VILAGUT
Credential	:
Telephone Number	:	714-933-6652

Provider Enumeration Date	:	11/21/2016
Last Update Date	:	11/21/2016

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Directions to “STEPHOUSE RECOVERY ” Practice Location

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