Healthcare Provider Details

I. General information

NPI: 1083543722
Provider Name (Legal Business Name): 1ST STEP RECOVERY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7848 GENESTA AVE
LAKE BALBOA CA
91406-1622
US

IV. Provider business mailing address

7848 GENESTA AVE
LAKE BALBOA CA
91406-1622
US

V. Phone/Fax

Practice location:
  • Phone: 818-574-5033
  • Fax: 818-574-5034
Mailing address:
  • Phone: 818-574-5033
  • Fax: 818-574-5034

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: SARGIS SAKO POSHOTYAN
Title or Position: CEO
Credential:
Phone: 747-238-2228