Organization
VOGUE RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE BOYADZHYAN (OWNER)
(818) 916-8116
Entity
Organization
Contact information
Practice address
4122 N 17TH ST, BUILDING A, PHOENIX, AZ 85016
(818) 304-0705
Mailing address
16501 SHERMAN WAY STE 100, VAN NUYS, CA 91406-3757
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IFBH9184
STATE LICENSE
AZ
Enumeration date
10/29/2018
Last updated
10/29/2018
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