Provider Demographics
NPI:1790464691
Name:APOLLO RECOVERY CENTER
Entity Type:Organization
Organization Name:APOLLO RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASILAUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-599-6653
Mailing Address - Street 1:3529 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-3731
Mailing Address - Country:US
Mailing Address - Phone:323-921-9055
Mailing Address - Fax:
Practice Address - Street 1:8539 YOLANDA AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4640
Practice Address - Country:US
Practice Address - Phone:561-569-6173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility