Provider Demographics
NPI:1689147365
Name:STAIRWAY RECOVERY, LLC
Entity Type:Organization
Organization Name:STAIRWAY RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:WENGER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:740-632-6383
Mailing Address - Street 1:6300 RIVERSIDE PLAZA LN NW STE 118 #96523
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120
Mailing Address - Country:US
Mailing Address - Phone:844-437-8247
Mailing Address - Fax:
Practice Address - Street 1:6300 RIVERSIDE PLAZA LN NW STE 118 #96523
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:844-437-8247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty