MEDICARE: RECOVERY DYNAMICS LLC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1972351716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY DYNAMICS LLC

Provider Business Mailing Address
First Line	:	1776 N HIGHLAND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-4404
Country	:	US
Telephone Number	:	213-333-3869
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 N HIGHLAND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-4404
Country	:	US
Telephone Number	:	213-333-3869
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SEAN TABIBIAN
Credential	:
Telephone Number	:	310-927-8811

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	12/08/2025

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