MEDICARE: OHANA RECOV ERY CENTER

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	191091AP	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1568132546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHANA RECOV ERY CENTER

Provider Business Mailing Address
First Line	:	1936 HAZEL NUT CT
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-6238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 HAZEL NUT CT
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-6238
Country	:	US
Telephone Number	:	818-571-9841
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ARTHUR MOGILEVSKI
Credential	:
Telephone Number	:	818-571-9841

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/20/2021

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Directions to “OHANA RECOV ERY CENTER ” Practice Location

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