Healthcare Provider Details

I. General information

NPI: 1134731011
Provider Name (Legal Business Name): ASTERI BEHAVIORAL TREATMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST STE 400
GARDENA CA
90248-4223
US

IV. Provider business mailing address

879 W 190TH ST STE 400
GARDENA CA
90248-4223
US

V. Phone/Fax

Practice location:
  • Phone: 818-232-2959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: VAKHTANG NAZARYAN
Title or Position: CEO
Credential:
Phone: 818-232-2959