Provider Demographics
NPI:1891825451
Name:STEP UP ON SECOND STREET, INC.
Entity Type:Organization
Organization Name:STEP UP ON SECOND STREET, INC.
Other - Org Name:STEP UP ON SECOND STREET-FCCS PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOD
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-394-6889
Mailing Address - Street 1:3435 OCEAN PARK BLVD
Mailing Address - Street 2:#207
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3301
Mailing Address - Country:US
Mailing Address - Phone:310-392-9474
Mailing Address - Fax:310-392-7341
Practice Address - Street 1:3435 OCEAN PARK BLVD
Practice Address - Street 2:#207
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3301
Practice Address - Country:US
Practice Address - Phone:310-392-9474
Practice Address - Fax:310-392-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health