Provider Demographics
NPI:1558932558
Name:STUDIO 64 RECOVERY
Entity Type:Organization
Organization Name:STUDIO 64 RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TALIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-800-9702
Mailing Address - Street 1:1716 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1313
Mailing Address - Country:US
Mailing Address - Phone:818-800-9702
Mailing Address - Fax:
Practice Address - Street 1:1716 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1313
Practice Address - Country:US
Practice Address - Phone:818-800-9702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility