Provider Demographics
NPI:1164893749
Name:SHELBY RECOVERY SERVICES INC.
Entity Type:Organization
Organization Name:SHELBY RECOVERY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BILGRAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-266-4447
Mailing Address - Street 1:287 S ROBERTSON BLVD
Mailing Address - Street 2:# 320
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2810
Mailing Address - Country:US
Mailing Address - Phone:424-266-4447
Mailing Address - Fax:424-255-9306
Practice Address - Street 1:279 E GREENHAVEN ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-2838
Practice Address - Country:US
Practice Address - Phone:424-266-4447
Practice Address - Fax:424-255-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190868AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility