MEDICARE: AGOURA RECOVERY COMMUNITY, 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	261QM0850X	Adult Mental Health Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1497548978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGOURA RECOVERY COMMUNITY, INC.

Provider Business Mailing Address
First Line	:	29219 CANWOOD ST # 108
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1560
Country	:	US
Telephone Number	:	661-600-5245
Fax Number	:

Provider Business Practice Location Address
First Line	:	29219 CANWOOD ST # 108
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1560
Country	:	US
Telephone Number	:	661-600-5245
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RILEY COLLINS
Credential	:	LMFT
Telephone Number	:	661-600-5245

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	05/27/2025

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