MEDICARE: DREAM RECOVERY 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

General Provider Information

NPI Number	:	1770431629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM RECOVERY CENTER

Provider Business Mailing Address
First Line	:	9849 CANEDO AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-1808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9849 CANEDO AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-1808
Country	:	US
Telephone Number	:	747-267-8637
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MIKAYEL GEVORGYAN
Credential	:
Telephone Number	:	747-267-8637

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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