=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912340852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETTER CHOICE OUTPATIENT TREATMENT CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2013
-----------------------------------------------------
Last Update Date | 04/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13858 1/2 CHASE ST
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-810-5848
-----------------------------------------------------
Fax | 818-810-5889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13858 1/2 CHASE ST
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-810-5848
-----------------------------------------------------
Fax | 818-810-5889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERVISOR
-----------------------------------------------------
Name | MR. HAKOB AVAGYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-810-5848
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------