Organization
GRATITUDE LODGE LLC
Active
Parent organization
GRATITUDE LODGE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRATITUDE LODGE LLC
Authorized official
BROOKS BUTLER (MANAGER)
(657) 218-9958
Entity
Organization
Contact information
Practice address
20182 KLINE DR, NEWPORT BEACH, CA 92660-1312
(657) 218-9958
(888) 411-0151
Mailing address
3849 CHATWIN AVE, LONG BEACH, CA 90808-2004
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
01/17/2020
Last updated
01/17/2020
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