MEDICARE: REFORM RECOVERY CENTER 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	:	1710792817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFORM RECOVERY CENTER INC

Provider Business Mailing Address
First Line	:	3022 N HOLLYWOOD WAY
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-1026
Country	:	US
Telephone Number	:	818-590-5189
Fax Number	:

Provider Business Practice Location Address
First Line	:	3022 N HOLLYWOOD WAY
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-1026
Country	:	US
Telephone Number	:	818-590-5189
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ARMOND TARVERYAN
Credential	:
Telephone Number	:	818-590-5189

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	02/07/2025

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