Provider Demographics
NPI:1346792835
Name:SHORTRIDGE ACADEMY
Entity Type:Organization
Organization Name:SHORTRIDGE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-334-2233
Mailing Address - Street 1:12424 WILSHIRE BLVD SUITE 800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-457-6302
Mailing Address - Fax:310-457-6318
Practice Address - Street 1:619 GOVERNORS ROAD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:NH
Practice Address - Zip Code:03851-4757
Practice Address - Country:US
Practice Address - Phone:603-403-2800
Practice Address - Fax:310-457-6318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTIOR HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-31
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children