Basic Information
| Provider Information | |||||||||
| NPI: | 1801174057 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOMENS RECOVERY ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 CHAPIN AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940104062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503486603 | ||||||||
| FaxNumber: | 6503480615 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 CHAPIN AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940104062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503486603 | ||||||||
| FaxNumber: | 6503480615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2011 | ||||||||
| LastUpdateDate: | 07/21/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MOORE WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | ANISSA | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | INTAKE SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6503486603 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.