Organization
310 RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALENTIN GASPARYAN (DIRECTOR)
(818) 208-5695
Entity
Organization
Contact information
Practice address
10533 WASHINGTON BLVD, CULVER CITY, CA 90232-3311
(818) 208-5695
Mailing address
10533 WASHINGTON BLVD, CULVER CITY, CA 90232-3311
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
190905AP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190905AP
DEPARTMENT OF HEALTH CARE SERVICES
CA
Enumeration date
05/26/2016
Last updated
05/26/2016
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