Provider Demographics
NPI:1487906871
Name:THE STEPHOUSE RECOVERY, INC.
Entity type:Organization
Organization Name:THE STEPHOUSE RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VILAGUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-394-3494
Mailing Address - Street 1:10529 SLATER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4841
Mailing Address - Country:US
Mailing Address - Phone:714-394-3494
Mailing Address - Fax:714-969-2889
Practice Address - Street 1:10529 SLATER AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-394-3494
Practice Address - Fax:714-969-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0801X
CA300251AP261QR0405X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)