Provider Demographics
NPI:1285067215
Name:WOMEN OF WORTH RECOVERY HOUSE
Entity type:Organization
Organization Name:WOMEN OF WORTH RECOVERY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-832-8075
Mailing Address - Street 1:2500 OLMO CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4420
Mailing Address - Country:US
Mailing Address - Phone:661-832-8075
Mailing Address - Fax:661-832-0375
Practice Address - Street 1:2500 OLMO CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4420
Practice Address - Country:US
Practice Address - Phone:661-832-8075
Practice Address - Fax:661-832-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150055AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility