Organization
MAPLE MOON RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY INGRAM (OWNER)
(213) 713-8027
Entity
Organization
Contact information
Practice address
20400 HEMMINGWAY ST, WINNETKA, CA 91306-2249
(213) 713-8027
Mailing address
20400 HEMMINGWAY ST, WINNETKA, CA 91306-2249
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
12/22/2021
Last updated
12/22/2021
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