Provider Demographics
NPI:1851045801
Name:LVRC INC
Entity Type:Organization
Organization Name:LVRC INC
Other - Org Name:LEONA VALLEY RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YERANUHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-219-5454
Mailing Address - Street 1:10620 ELIZABETH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LEONA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93551-7012
Mailing Address - Country:US
Mailing Address - Phone:661-270-1023
Mailing Address - Fax:
Practice Address - Street 1:10620 ELIZABETH LAKE RD
Practice Address - Street 2:
Practice Address - City:LEONA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93551-7012
Practice Address - Country:US
Practice Address - Phone:661-270-1023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility