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NPI Code Detail

MEDICARE: DETOXERY

MEDICARE: DETOXERY
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1376339630
Entity Type Code : Organization
Provider Name (Legal Business Name) : DETOXERY
Provider Business Mailing Address
First Line : 3147 E SIERRA MADRE BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-2037
Country : US
Telephone Number : 626-437-0500
Fax Number :
Provider Business Practice Location Address
First Line : 3147 E SIERRA MADRE BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-2037
Country : US
Telephone Number : 626-437-0500
Fax Number :
Authorized Official
Title or Position : CFO
Name : SHANT AGADJANIAN
Credential :
Telephone Number : 626-437-0500
Provider Enumeration Date : 04/15/2025
Last Update Date : 04/15/2025

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Directions to “DETOXERY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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