Basic Information
| Provider Information | |||||||||
| NPI: | 1619229713 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOMEN'S RECOVERY ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 CHAPIN AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940104062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503486603 | ||||||||
| FaxNumber: | 6503480625 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 CHAPIN AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940104062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503486603 | ||||||||
| FaxNumber: | 6503480625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2012 | ||||||||
| LastUpdateDate: | 06/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | WETZEL | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/EXECUTIVE | ||||||||
| AuthorizedOfficialTelephone: | 6503486603 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.