Healthcare Provider Details

I. General information

NPI: 1629433552
Provider Name (Legal Business Name): MOTIVATIONAL RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 S CENTRAL AVE
LOS ANGELES CA
90011-1237
US

IV. Provider business mailing address

4081 W 130TH ST
HAWTHORNE CA
90250-5270
US

V. Phone/Fax

Practice location:
  • Phone: 213-493-4664
  • Fax:
Mailing address:
  • Phone: 310-310-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. SARKIS KARAGEOZYAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 818-266-8969