Provider Demographics
NPI:1437609773
Name:WESTSIDE SOBER LIVING CENTERS, INC
Entity Type:Organization
Organization Name:WESTSIDE SOBER LIVING CENTERS, INC
Other - Org Name:PROMISES PTP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR RCM
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLESDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CHC, CHPC
Authorized Official - Phone:615-510-3708
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:615-261-8912
Practice Address - Street 1:2515 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4615
Practice Address - Country:US
Practice Address - Phone:866-595-3105
Practice Address - Fax:424-272-9303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELEMENTS BEHAVIORAL HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190625GP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility