Healthcare Provider Details

I. General information

NPI: 1568280691
Provider Name (Legal Business Name): HOLLYCARE RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14242 VENTURA BLVD STE 235
SHERMAN OAKS CA
91423-2757
US

IV. Provider business mailing address

14242 VENTURA BLVD STE 235
SHERMAN OAKS CA
91423-2757
US

V. Phone/Fax

Practice location:
  • Phone: 818-934-2200
  • Fax:
Mailing address:
  • Phone: 818-934-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISHA KHUDAVERDYAN
Title or Position: CEO
Credential:
Phone: 818-934-2200