Provider Demographics
NPI:1992139406
Name:WOMENS RECOVERY ASSOCIATION
Entity type:Organization
Organization Name:WOMENS RECOVERY ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTAKE SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LELEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-348-6603
Mailing Address - Street 1:1818 GILBRETH RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1225
Mailing Address - Country:US
Mailing Address - Phone:650-348-6603
Mailing Address - Fax:650-652-2440
Practice Address - Street 1:1818 GILBRETH RD
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1225
Practice Address - Country:US
Practice Address - Phone:650-348-6603
Practice Address - Fax:650-652-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness