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General NPI Number Information
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NPI Number | 1437637014
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Entity Type | Organization
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Legal Business Name | O/G RECOVERY
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Dates
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Enumeration Date | 08/05/2018
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Last Update Date | 08/05/2018
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Provider Practice Location Address
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Address Line | 6078 SELMA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90028-6415
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Country | US
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Telephone | 310-499-3112
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Fax |
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Provider Business Mailing Address
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Address Line | 12801 MILBANK ST
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City | STUDIO CITY
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State | CA
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Zip | 91604-1354
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Country | US
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Telephone | 310-499-3112
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY ADAM HOLDEN
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Credential |
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Telephone | 310-499-3112
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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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