Healthcare Provider Details

I. General information

NPI: 1649195702
Provider Name (Legal Business Name): BELLAGIO SERENITY RECOVERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14122 ALBERS ST
SHERMAN OAKS CA
91401-4905
US

IV. Provider business mailing address

14122 ALBERS ST
SHERMAN OAKS CA
91401-4905
US

V. Phone/Fax

Practice location:
  • Phone: 323-459-9708
  • Fax: 206-647-8776
Mailing address:
  • Phone: 323-459-9708
  • Fax: 206-647-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DMITRY JAMES NAYGAS
Title or Position: CEO
Credential:
Phone: 323-459-9708