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General NPI Number Information
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NPI Number | 1053516567
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Entity Type | Organization
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Legal Business Name | KB RECOVERY INC.
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15722 TUPPER ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-3124
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Country | US
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Telephone | 818-891-3639
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Fax | 818-892-9471
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Provider Business Mailing Address
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Address Line | 15722 TUPPER ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-3124
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Country | US
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Telephone | 818-891-3639
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Fax | 818-892-9471
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KEVIN BABAYAN
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Credential | M.A.
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Telephone | 818-891-3639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 190527AP
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License Number State | CA
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