Provider Demographics
NPI:1245096726
Name:WEST LA RECOVERY LLC
Entity type:Organization
Organization Name:WEST LA RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:310-592-0139
Mailing Address - Street 1:1728 ABBOT KINNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4839
Mailing Address - Country:US
Mailing Address - Phone:310-439-1799
Mailing Address - Fax:
Practice Address - Street 1:1728 ABBOT KINNEY BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-4839
Practice Address - Country:US
Practice Address - Phone:310-439-1799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health