MEDICARE: STAIRWAY TO RECOVERY DRUG AND ALCOHOL REHABILITAITON FACILITY

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	:	1811169105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAIRWAY TO RECOVERY DRUG AND ALCOHOL REHABILITAITON FACILITY

Provider Business Mailing Address
First Line	:	6102 SOUTH BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1428
Country	:	US
Telephone Number	:	323-526-1073
Fax Number	:

Provider Business Practice Location Address
First Line	:	6102 SOUTH BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1428
Country	:	US
Telephone Number	:	661-236-7765
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICE
Name	:	MRS. SHRAWNDA HARRIS
Credential	:
Telephone Number	:	661-236-7765

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	02/17/2010

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Directions to “STAIRWAY TO RECOVERY DRUG AND ALCOHOL REHABILITAITON FACILITY ” Practice Location

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