Provider Demographics
NPI:1285186353
Name:STEP UP ON SECOND STREET INC.
Entity Type:Organization
Organization Name:STEP UP ON SECOND STREET INC.
Other - Org Name:STEP UP ON SECOND-SAN BERNARDINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOD
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-963-5355
Mailing Address - Street 1:600 N ARROWHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1164
Mailing Address - Country:US
Mailing Address - Phone:909-963-5355
Mailing Address - Fax:424-500-8526
Practice Address - Street 1:600 N ARROWHEAD AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1164
Practice Address - Country:US
Practice Address - Phone:909-963-5355
Practice Address - Fax:424-500-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health