Provider Demographics
NPI:1619229713
Name:WOMEN'S RECOVERY ASSOCIATION
Entity Type:Organization
Organization Name:WOMEN'S RECOVERY ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-348-6603
Mailing Address - Street 1:1450 CHAPIN AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4062
Mailing Address - Country:US
Mailing Address - Phone:650-348-6603
Mailing Address - Fax:650-348-0625
Practice Address - Street 1:1450 CHAPIN AVE
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4062
Practice Address - Country:US
Practice Address - Phone:650-348-6603
Practice Address - Fax:650-348-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility