Provider Demographics
NPI:1619598208
Name:CONQUER RECOVERY CENTERS, INC.
Entity Type:Organization
Organization Name:CONQUER RECOVERY CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVITIAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:818-262-0110
Mailing Address - Street 1:2360 JUPITER DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2026
Mailing Address - Country:US
Mailing Address - Phone:818-262-0110
Mailing Address - Fax:323-851-4957
Practice Address - Street 1:1324 KENISTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1713
Practice Address - Country:US
Practice Address - Phone:323-391-3755
Practice Address - Fax:323-851-4957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility