Healthcare Provider Details

I. General information

NPI: 1710814470
Provider Name (Legal Business Name): MONTEBELLO ADDICTION TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N MONTEBELLO BLVD STE 203
MONTEBELLO CA
90640-4274
US

IV. Provider business mailing address

420 N MONTEBELLO BLVD STE 203
MONTEBELLO CA
90640-4274
US

V. Phone/Fax

Practice location:
  • Phone: 323-314-9464
  • Fax:
Mailing address:
  • Phone: 323-314-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: YENOK KOPUSHYAN
Title or Position: CFO
Credential:
Phone: 323-314-9464