Healthcare Provider Details

I. General information

NPI: 1770141764
Provider Name (Legal Business Name): 310 RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 HAUSER BLVD
LOS ANGELES CA
90019-5111
US

IV. Provider business mailing address

1741 HAUSER BLVD
LOS ANGELES CA
90019-5111
US

V. Phone/Fax

Practice location:
  • Phone: 310-935-9849
  • Fax:
Mailing address:
  • Phone:
  • 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: VALENTIN GASPARYAN
Title or Position: MANAGER
Credential:
Phone: 818-206-5695