Healthcare Provider Details

I. General information

NPI: 1194438960
Provider Name (Legal Business Name): 88'S REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 N MYERS ST
BURBANK CA
91504-1730
US

IV. Provider business mailing address

2912 N MYERS ST
BURBANK CA
91504-1730
US

V. Phone/Fax

Practice location:
  • Phone: 818-939-9056
  • Fax:
Mailing address:
  • Phone: 818-939-9056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: EDUARD GABRIEL GABRIELYA
Title or Position: CEO
Credential:
Phone: 818-749-1060