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General NPI Number Information
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NPI Number | 1619598208
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Entity Type | Organization
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Legal Business Name | CONQUER RECOVERY CENTERS, INC.
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 1324 KENISTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90019-1713
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Country | US
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Telephone | 323-391-3755
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Fax | 323-851-4957
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Provider Business Mailing Address
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Address Line | 2360 JUPITER DR
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City | LOS ANGELES
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State | CA
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Zip | 90046-2026
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Country | US
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Telephone | 818-262-0110
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Fax | 323-851-4957
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVID DAVITIAN
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Credential | BA
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Telephone | 818-262-0110
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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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