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General NPI Number Information
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NPI Number | 1780030403
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE RECOVERY SOLUTIONS, LLC
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 8150 MORSE AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91605-1020
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Country | US
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Telephone | 818-922-2458
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Fax | 818-922-2457
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Provider Business Mailing Address
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Address Line | 8150 MORSE AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91605-1020
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Country | US
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Telephone | 818-922-2458
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Fax | 818-922-2457
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ASHOT VARDANYAN
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Credential |
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Telephone | 323-803-8870
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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 | CA
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