Healthcare Provider Details

I. General information

NPI: 1598291387
Provider Name (Legal Business Name): COMFORT RECOVERY IOP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/25/2024
Certification Date: 05/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30851 AGOURA RD STE 102
AGOURA HILLS CA
91301-4343
US

IV. Provider business mailing address

30851 AGOURA RD STE 102
AGOURA HILLS CA
91301-4343
US

V. Phone/Fax

Practice location:
  • Phone: 818-579-9687
  • Fax: 818-914-4499
Mailing address:
  • Phone: 818-522-2213
  • 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
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190005AP
License Number StateCA

VIII. Authorized Official

Name: MR. HOVSEP SHIRIKCHYAN
Title or Position: CEO
Credential:
Phone: 818-522-2213