MEDICARE: KB RECOVERY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	190527AP	CA

General Provider Information

NPI Number	:	1053516567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KB RECOVERY INC.

Provider Business Mailing Address
First Line	:	15722 TUPPER ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-3124
Country	:	US
Telephone Number	:	818-891-3639
Fax Number	:	818-892-9471

Provider Business Practice Location Address
First Line	:	15722 TUPPER ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-3124
Country	:	US
Telephone Number	:	818-891-3639
Fax Number	:	818-892-9471

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. KEVIN BABAYAN
Credential	:	M.A.
Telephone Number	:	818-891-3639

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	08/22/2020

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