Provider Demographics
NPI:1649309469
Name:STEP UP ON SECOND STREET, INC.
Entity type:Organization
Organization Name:STEP UP ON SECOND STREET, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:1619 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1807
Mailing Address - Country:US
Mailing Address - Phone:310-392-5855
Mailing Address - Fax:310-453-4817
Practice Address - Street 1:1619 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1807
Practice Address - Country:US
Practice Address - Phone:310-392-5855
Practice Address - Fax:310-453-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health