Provider Demographics
NPI:1710693361
Name:CANYON RECOVERY CENTER INC
Entity Type:Organization
Organization Name:CANYON RECOVERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEVORK
Authorized Official - Middle Name:
Authorized Official - Last Name:SRAPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:323-646-6464
Mailing Address - Street 1:17655 SCHERZINGER LN
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1649
Mailing Address - Country:US
Mailing Address - Phone:323-646-6464
Mailing Address - Fax:
Practice Address - Street 1:17655 SCHERZINGER LN
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-1649
Practice Address - Country:US
Practice Address - Phone:323-646-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TBDOtherTBD