Provider Demographics
NPI:1508534934
Name:4 SEASON DETOX AND RECOVERY HOUSE INC
Entity Type:Organization
Organization Name:4 SEASON DETOX AND RECOVERY HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ARSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAROYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-813-4363
Mailing Address - Street 1:3174 EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-1568
Mailing Address - Country:US
Mailing Address - Phone:818-813-4363
Mailing Address - Fax:424-389-7733
Practice Address - Street 1:3174 EVELYN AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-1568
Practice Address - Country:US
Practice Address - Phone:424-242-2540
Practice Address - Fax:661-296-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility