MEDICARE: ACCOLADE 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	:	1912704867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCOLADE RECOVERY, INC.

Provider Business Mailing Address
First Line	:	22209 DOLOROSA ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4437
Country	:	US
Telephone Number	:	818-660-2475
Fax Number	:	818-707-5528

Provider Business Practice Location Address
First Line	:	22209 DOLOROSA ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4437
Country	:	US
Telephone Number	:	818-660-2475
Fax Number	:	818-707-5528

Authorized Official
Title or Position	:	CEO
Name	:	RUBEN SUKIASYAN
Credential	:
Telephone Number	:	818-660-2475

Provider Enumeration Date	:	02/27/2025
Last Update Date	:	02/27/2025

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