Provider Demographics
NPI:1174192264
Name:LA VALLEY RECOVERY
Entity Type:Organization
Organization Name:LA VALLEY RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-900-0858
Mailing Address - Street 1:7757 MARY ELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7744 MARY ELLEN AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1928
Practice Address - Country:US
Practice Address - Phone:818-900-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility