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NPI Code Detail

MEDICARE: KKG RECOVERY CENTER

MEDICARE: KKG 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
1324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1942155445
Entity Type Code : Organization
Provider Name (Legal Business Name) : KKG RECOVERY CENTER
Provider Business Mailing Address
First Line : 12019 RATNER ST
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-1411
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12019 RATNER ST
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-1411
Country : US
Telephone Number : 818-422-4004
Fax Number :
Authorized Official
Title or Position : CONSULTANT
Name : MANNE OGANYAN
Credential : MPA
Telephone Number : 818-422-4004
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “KKG RECOVERY CENTER ” Practice Location

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