MEDICARE: AVEDIS RECOVERY 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1790341568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVEDIS RECOVERY INC.

Provider Business Mailing Address
First Line	:	1249 S LA BREA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-1627
Country	:	US
Telephone Number	:	323-243-3422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1249 S LA BREA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-1627
Country	:	US
Telephone Number	:	323-243-3422
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GEORGE SARKIS DEGIRMENDJIAN
Credential	:
Telephone Number	:	323-243-3422

Provider Enumeration Date	:	05/16/2019
Last Update Date	:	05/16/2019

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Directions to “AVEDIS RECOVERY INC. ” Practice Location

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