Provider Demographics
NPI:1326732199
Name:LAKERIDGE RECOVERY CENTER
Entity Type:Organization
Organization Name:LAKERIDGE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARSHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-202-2000
Mailing Address - Street 1:6664 LAKERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1816
Mailing Address - Country:US
Mailing Address - Phone:424-202-0000
Mailing Address - Fax:
Practice Address - Street 1:6664 LAKERIDGE RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1816
Practice Address - Country:US
Practice Address - Phone:424-202-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder