Healthcare Provider Details

I. General information

NPI: 1821925819
Provider Name (Legal Business Name): MONTEBELLO RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1018 W YORKTOWN AVE
MONTEBELLO CA
90640-2557
US

IV. Provider business mailing address

1018 W YORKTOWN AVE
MONTEBELLO CA
90640-2557
US

V. Phone/Fax

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

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