=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659193027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACEFUL LIFE RECOVERY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2024
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8508 OSO AVE
-----------------------------------------------------
City | WINNETKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91306-1341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-351-8196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8508 OSO AVE
-----------------------------------------------------
City | WINNETKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91306-1341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-351-8196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. VAHE MARGARYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 747-351-8196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------