1164709895 NPI number — SOCIAL MODEL RECOVERY SYSTEMS, INC.

Table of content: (NPI 1164709895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164709895 NPI number — SOCIAL MODEL RECOVERY SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOCIAL MODEL RECOVERY SYSTEMS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STEPPING STONES HOME I & II
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164709895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
223 E ROWLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91723-3147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-967-2677
Provider Business Mailing Address Fax Number:
626-858-4923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17727, 17719 E CYPRESS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91722-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-858-4920
Provider Business Practice Location Address Fax Number:
626-858-4923
Provider Enumeration Date:
11/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HALE
Authorized Official First Name:
LYNETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR OF CLINICAL SERVICE
Authorized Official Telephone Number:
626-332-3145

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  190118BN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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