Provider Demographics
NPI:1790942159
Name:GRASSHOPPER HOUSE, LLC
Entity Type:Organization
Organization Name:GRASSHOPPER HOUSE, LLC
Other - Org Name:PASSAGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-589-2880
Mailing Address - Street 1:6428 MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4492
Mailing Address - Country:US
Mailing Address - Phone:310-589-2880
Mailing Address - Fax:310-589-2869
Practice Address - Street 1:6428 MEADOWS CT
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4492
Practice Address - Country:US
Practice Address - Phone:310-589-2880
Practice Address - Fax:310-589-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility