Healthcare Provider Details

I. General information

NPI: 1831054329
Provider Name (Legal Business Name): PROSPECT DETOX CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 DENSMORE AVE
VAN NUYS CA
91406-6020
US

IV. Provider business mailing address

6424 DENSMORE AVE
VAN NUYS CA
91406-6020
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 999-999-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ARTUR SHIRINYAN
Title or Position: CEO
Credential:
Phone: 999-999-9999