Provider Demographics
NPI:1750408464
Name:STEPPING STONE OF SAN DIEGO
Entity type:Organization
Organization Name:STEPPING STONE OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS & HR MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-278-0777
Mailing Address - Street 1:3928 ILLINOIS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3058
Mailing Address - Country:US
Mailing Address - Phone:619-278-0777
Mailing Address - Fax:
Practice Address - Street 1:3928 ILLINOIS ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104
Practice Address - Country:US
Practice Address - Phone:619-278-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPPING STONE OF SAN DIEGO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276400000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit