MEDICARE: REST & RESTORE LIVING REHAB CENTER 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	:	1104763382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REST & RESTORE LIVING REHAB CENTER INC

Provider Business Mailing Address
First Line	:	11574 YARMOUTH AVE
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-2158
Country	:	US
Telephone Number	:	323-920-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	11574 YARMOUTH AVE
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-2158
Country	:	US
Telephone Number	:	323-920-0202
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. GAGIK ALTUNYAN
Credential	:
Telephone Number	:	323-920-0202

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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