Provider Demographics
NPI:1114412392
Name:FAITH RECOVERY CENTER, INC
Entity Type:Organization
Organization Name:FAITH RECOVERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-220-3089
Mailing Address - Street 1:2200 COLDWATER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1737
Mailing Address - Country:US
Mailing Address - Phone:818-220-3089
Mailing Address - Fax:
Practice Address - Street 1:2200 COLDWATER CANYON DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-1737
Practice Address - Country:US
Practice Address - Phone:818-220-3089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility