Healthcare Provider Details

I. General information

NPI: 1518181379
Provider Name (Legal Business Name): HOLLYWOOD RECOVERY TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 RIVERSIDE DR STE 211
STUDIO CITY CA
91607-3436
US

IV. Provider business mailing address

12500 RIVERSIDE DR STE 211
STUDIO CITY CA
91607-3436
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-0849
  • Fax: 818-980-0859
Mailing address:
  • Phone: 818-980-0849
  • Fax: 818-980-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6895
License Number StateCA

VIII. Authorized Official

Name: MARTIN AGUILAR
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 818-980-0849