Healthcare Provider Details

I. General information

NPI: 1497548978
Provider Name (Legal Business Name): AGOURA RECOVERY COMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29219 CANWOOD ST # 108
AGOURA HILLS CA
91301-1560
US

IV. Provider business mailing address

29219 CANWOOD ST # 108
AGOURA HILLS CA
91301-1560
US

V. Phone/Fax

Practice location:
  • Phone: 661-600-5245
  • Fax:
Mailing address:
  • Phone: 661-600-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RILEY COLLINS
Title or Position: CEO
Credential: LMFT
Phone: 661-600-5245