Provider Demographics
NPI:1609227636
Name:LADIES RECOVERY 4 LIFE
Entity Type:Organization
Organization Name:LADIES RECOVERY 4 LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERV./SUPERVISING CSLR.
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA CATC CCS #15096
Authorized Official - Phone:805-743-1515
Mailing Address - Street 1:115 N D ST
Mailing Address - Street 2:STREET, UNIT A
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6911
Mailing Address - Country:US
Mailing Address - Phone:805-588-4410
Mailing Address - Fax:805-819-0942
Practice Address - Street 1:115 N D ST
Practice Address - Street 2:STREET, UNIT A
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6911
Practice Address - Country:US
Practice Address - Phone:805-588-4410
Practice Address - Fax:805-819-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility