Provider Demographics
NPI:1518181379
Name:HOLLYWOOD RECOVERY TREATMENT CENTER
Entity Type:Organization
Organization Name:HOLLYWOOD RECOVERY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-980-0849
Mailing Address - Street 1:12500 RIVERSIDE DR STE 211
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3436
Mailing Address - Country:US
Mailing Address - Phone:818-980-0849
Mailing Address - Fax:818-980-0859
Practice Address - Street 1:12500 RIVERSIDE DR STE 211
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91607-3436
Practice Address - Country:US
Practice Address - Phone:818-980-0849
Practice Address - Fax:818-980-0859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLLYWOOD RECOVERY TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA6895251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6895OtherPROVIDER NUMBER