Provider Demographics
NPI:1912292012
Name:THIRD STREET TREATMENT PARTNERS, LLC
Entity Type:Organization
Organization Name:THIRD STREET TREATMENT PARTNERS, LLC
Other - Org Name:WALKING MIRACLES RECOVERY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BATHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-268-7242
Mailing Address - Street 1:4067 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3120
Mailing Address - Country:US
Mailing Address - Phone:888-870-2201
Mailing Address - Fax:
Practice Address - Street 1:4067 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3120
Practice Address - Country:US
Practice Address - Phone:888-870-2201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility