Healthcare Provider Details

I. General information

NPI: 1972935005
Provider Name (Legal Business Name): HOLLYWOOD RECOVERY TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
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 Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN AGUILAR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 818-980-0849