Healthcare Provider Details

I. General information

NPI: 1720995749
Provider Name (Legal Business Name): KOKORO RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21315 COMMUNITY ST
CANOGA PARK CA
91304-2729
US

IV. Provider business mailing address

14761 DEVONSHIRE ST
MISSION HILLS CA
91345-2818
US

V. Phone/Fax

Practice location:
  • Phone: 626-224-3711
  • Fax:
Mailing address:
  • Phone: 626-224-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GOEL SOHMEKH
Title or Position: FOUNDER
Credential:
Phone: 626-224-3711