Provider Demographics
NPI:1023463999
Name:YELLOWSTONE WOMEN'S FIRST STEP HOUSE INC.
Entity type:Organization
Organization Name:YELLOWSTONE WOMEN'S FIRST STEP HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:RADT 1
Authorized Official - Phone:949-678-3014
Mailing Address - Street 1:154 E BAY ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2147
Mailing Address - Country:US
Mailing Address - Phone:888-941-9048
Mailing Address - Fax:949-646-5296
Practice Address - Street 1:2001 HARBOR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:888-941-9048
Practice Address - Fax:949-646-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300121IN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty