MEDICARE: NEELAH, 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

General Provider Information

NPI Number	:	1063886521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEELAH, INC

Provider Business Mailing Address
First Line	:	10234 CANDLEBERRY LN
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-1268
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4924 QUEEN VICTORIA RD
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-4754
Country	:	US
Telephone Number	:	818-400-2365
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NADYA MAHDAVI
Credential	:
Telephone Number	:	818-415-9699

Provider Enumeration Date	:	11/20/2015
Last Update Date	:	11/20/2015

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Directions to “NEELAH, INC ” Practice Location

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