Provider Demographics
NPI:1477234516
Name:THE RUNWAY OF CALIFORNIA, LLC
Entity type:Organization
Organization Name:THE RUNWAY OF CALIFORNIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:OSENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:C052570518
Authorized Official - Phone:714-299-1729
Mailing Address - Street 1:1245 W CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-4535
Mailing Address - Country:US
Mailing Address - Phone:714-299-1729
Mailing Address - Fax:657-210-4439
Practice Address - Street 1:1245 W CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-4535
Practice Address - Country:US
Practice Address - Phone:714-299-1729
Practice Address - Fax:657-210-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility