MEDICARE: MOTIVATIONAL RECOVERY SERVICES

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1629433552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTIVATIONAL RECOVERY SERVICES

Provider Business Mailing Address
First Line	:	4081 W 130TH ST
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-5270
Country	:	US
Telephone Number	:	310-310-4599
Fax Number	:

Provider Business Practice Location Address
First Line	:	2116 S CENTRAL AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-1237
Country	:	US
Telephone Number	:	213-493-4664
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. SARKIS KARAGEOZYAN
Credential	:
Telephone Number	:	818-266-8969

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	01/04/2016

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