Provider Demographics
NPI:1063637890
Name:WESTSIDE SOBER LIVING CENTERS
Entity Type:Organization
Organization Name:WESTSIDE SOBER LIVING CENTERS
Other - Org Name:PROMISES RESIDENTIAL TREATMENT CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CPC, CHC, CHPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLESDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-510-3078
Mailing Address - Street 1:PO BOX 670549
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-0549
Mailing Address - Country:US
Mailing Address - Phone:615-567-7282
Mailing Address - Fax:615-807-2931
Practice Address - Street 1:3743 S BARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3218
Practice Address - Country:US
Practice Address - Phone:310-390-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190074BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility