Organization
GRATITUDE LODGE
Active
Parent organization
GRATITUDE LODGE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRATITUDE LODGE LLC
Authorized official
MARK WILLIAMS (CO FOUNDER)
(781) 330-2124
Entity
Organization
Contact information
Practice address
20132 REDLANDS DR, NEWPORT BEACH, CA 92660-1324
(781) 330-2124
Mailing address
3849 CHATWIN AVE, LONG BEACH, CA 90808-2004
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/10/2021
Last updated
03/10/2021
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