Healthcare Provider Details

I. General information

NPI: 1992338255
Provider Name (Legal Business Name): AIM 4 RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2948 1/2 HONOLULU AVE
LA CRESCENTA CA
91214-3909
US

IV. Provider business mailing address

2948 1/2 HONOLULU AVE
LA CRESCENTA CA
91214-3909
US

V. Phone/Fax

Practice location:
  • Phone: 818-351-2337
  • Fax:
Mailing address:
  • Phone: 818-351-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ANGELIQUE NICOLE SHIRVANIAN
Title or Position: CFO
Credential: CADC-II
Phone: 818-351-2337