MEDICARE: LANDALE RECOVERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1770277543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDALE RECOVERY CENTER

Provider Business Mailing Address
First Line	:	6455 AND 6457 BAKMAN AVENUE
Second Line	:
City	:	NORTH HOLYWOOD
State	:	CA
Zip	:	91606
Country	:	US
Telephone Number	:	818-572-6438
Fax Number	:

Provider Business Practice Location Address
First Line	:	6455 AND 6457 BAKMAN AVENUE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606
Country	:	US
Telephone Number	:	818-572-6438
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HOVHANNES TSHAVRUSHYAN
Credential	:
Telephone Number	:	818-572-6438

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	07/26/2024

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Directions to “LANDALE RECOVERY CENTER ” Practice Location

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