Provider Demographics
NPI:1720644602
Name:THE STEPHOUSE RECOVERY, INC.
Entity Type:Organization
Organization Name:THE STEPHOUSE RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THE STEPHOUSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RECOVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-923-7623
Mailing Address - Street 1:10529 SLATER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4841
Mailing Address - Country:US
Mailing Address - Phone:714-873-3032
Mailing Address - Fax:
Practice Address - Street 1:1601 BAKER ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3701
Practice Address - Country:US
Practice Address - Phone:888-923-7623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility