Provider Demographics
NPI:1184473795
Name:AVALANCHE RECOVERY CENTER LLC
Entity type:Organization
Organization Name:AVALANCHE RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MERUZHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKOPYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-631-1545
Mailing Address - Street 1:12022 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2843
Mailing Address - Country:US
Mailing Address - Phone:818-515-8800
Mailing Address - Fax:
Practice Address - Street 1:14557 FRIAR ST STE A3
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2312
Practice Address - Country:US
Practice Address - Phone:818-515-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit