Provider Demographics
NPI:1073174546
Name:SYNTHESIS RECOVERY INC.
Entity Type:Organization
Organization Name:SYNTHESIS RECOVERY INC.
Other - Org Name:SYNTHESIS RECOVERY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGEI
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-498-3626
Mailing Address - Street 1:2238 KIRSTEN LEE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5564
Mailing Address - Country:US
Mailing Address - Phone:310-498-3626
Mailing Address - Fax:
Practice Address - Street 1:1752 CORRAL CANYON RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2906
Practice Address - Country:US
Practice Address - Phone:310-498-3626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility