Healthcare Provider Details

I. General information

NPI: 1700678786
Provider Name (Legal Business Name): REBOOT RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7744 MARY ELLEN AVE
NORTH HOLLYWOOD CA
91605-1928
US

IV. Provider business mailing address

7744 MARY ELLEN AVE
NORTH HOLLYWOOD CA
91605-1928
US

V. Phone/Fax

Practice location:
  • Phone: 818-687-0059
  • Fax:
Mailing address:
  • Phone: 818-687-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA ELKHOURY
Title or Position: CEO / PROGRAM DIRECTOR
Credential:
Phone: 818-687-0059