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General NPI Number Information
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NPI Number | 1326669011
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Entity Type | Organization
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Legal Business Name | NORTHSTAR DETOX & REHAB CENTER, LLC
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Dates
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Enumeration Date | 05/04/2020
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 19500 WINIFRED ST
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City | TARZANA
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State | CA
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Zip | 91356-3815
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Country | US
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Telephone | 818-928-2042
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Fax | 818-928-2043
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Provider Business Mailing Address
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Address Line | 19500 WINIFRED ST
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City | TARZANA
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State | CA
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Zip | 91356-3815
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Country | US
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Telephone | 818-928-2042
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Fax | 818-928-2043
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | HOSSEIN JOUKAR
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Credential | MD
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Telephone | 305-319-1133
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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 |
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License Number State |
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