Healthcare Provider Details

I. General information

NPI: 1124706221
Provider Name (Legal Business Name): LOS ANGELES COUNTY ADDICTION TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 SAPPHIRE DR
ENCINO CA
91436-4234
US

IV. Provider business mailing address

3650 SAPPHIRE DR
ENCINO CA
91436-4234
US

V. Phone/Fax

Practice location:
  • Phone: 661-666-0233
  • Fax:
Mailing address:
  • Phone: 661-666-0233
  • 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: ASHOT VARDANYAN
Title or Position: PRESIDENT
Credential:
Phone: 213-347-4747