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General NPI Number Information
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NPI Number | 1780364224
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Entity Type | Organization
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Legal Business Name | THE HOLLYWOOD & VINE RECOVERY CENTER
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 20933 DEVONSHIRE ST STE 102
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City | CHATSWORTH
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State | CA
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Zip | 91311-2397
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Country | US
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Telephone | 818-626-8505
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Fax |
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Provider Business Mailing Address
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Address Line | 9950 TOPANGA CANYON BLVD UNIT 28
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City | CHATSWORTH
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State | CA
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Zip | 91311-8337
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Country | US
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Telephone | 818-606-3403
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANNECA PEOPLES
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Credential |
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Telephone | 818-606-3403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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