Organization
PROVIDENCE DETOX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MHER DANIELYAN (CEO)
(818) 940-0308
Entity
Organization
Contact information
Practice address
20454 HEMMINGWAY ST, WINNETKA, CA 91306-2249
(818) 940-0308
(310) 758-0982
Mailing address
20454 HEMMINGWAY ST, WINNETKA, CA 91306-2249
(818) 940-0308
(310) 758-0982
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/11/2026
Last updated
08/11/2026
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