Provider Demographics
NPI:1215380001
Name:SL START CA, LLC
Entity Type:Organization
Organization Name:SL START CA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-209-2777
Mailing Address - Street 1:5709 W SUNSET HWY
Mailing Address - Street 2:#100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-6005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19300 S HAMILTON AVE
Practice Address - Street 2:STE 130
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4400
Practice Address - Country:US
Practice Address - Phone:310-327-7845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMBASSY MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities