MEDICARE: ADVANCE LIFE RECOVERY

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	:	1245121805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE LIFE RECOVERY

Provider Business Mailing Address
First Line	:	9350 TAMPA AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-2744
Country	:	US
Telephone Number	:	888-929-2891
Fax Number	:	818-483-9859

Provider Business Practice Location Address
First Line	:	9350 TAMPA AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-2744
Country	:	US
Telephone Number	:	888-929-2891
Fax Number	:	818-483-9859

Authorized Official
Title or Position	:	CEO
Name	:	DAVIT KSACHIKYAN
Credential	:
Telephone Number	:	888-929-2891

Provider Enumeration Date	:	07/11/2025
Last Update Date	:	07/11/2025

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Directions to “ADVANCE LIFE RECOVERY ” Practice Location

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