Provider Demographics
NPI:1508443854
Name:TARZANA RECOVERY CENTER, INC,
Entity Type:Organization
Organization Name:TARZANA RECOVERY CENTER, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-524-8605
Mailing Address - Street 1:5371 VANALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5371 VANALDEN AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3106
Practice Address - Country:US
Practice Address - Phone:818-524-8605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA191080APOtherDHCS