MEDICARE: HOLY ADDICTION CARE 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	:	1811223076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY ADDICTION CARE CENTER, INC

Provider Business Mailing Address
First Line	:	6260 LAUREL CANYON BLVD STE 103
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3238
Country	:	US
Telephone Number	:	424-333-1823
Fax Number	:	213-481-9944

Provider Business Practice Location Address
First Line	:	6260 LAUREL CANYON BLVD STE 103
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3238
Country	:	US
Telephone Number	:	747-204-8884
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	NAREK OGANYAN
Credential	:
Telephone Number	:	818-524-8605

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	05/23/2024

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