Provider Demographics
NPI:1518687367
Name:SAL PSYCHIATRY SERVICES PC
Entity Type:Organization
Organization Name:SAL PSYCHIATRY SERVICES PC
Other - Org Name:SAL REDISCOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:HASMIK
Authorized Official - Middle Name:JASMINE
Authorized Official - Last Name:AVETISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-469-9099
Mailing Address - Street 1:12440 FIRESTONE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4397
Mailing Address - Country:US
Mailing Address - Phone:562-280-7176
Mailing Address - Fax:562-262-0735
Practice Address - Street 1:12440 FIRESTONE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4397
Practice Address - Country:US
Practice Address - Phone:562-280-7176
Practice Address - Fax:562-262-0735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAL PSYCHIATRY SERVICES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-31
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility