Provider Demographics
NPI:1457030132
Name:CROSSPOINTE RECOVERY OUTPATIENT
Entity Type:Organization
Organization Name:CROSSPOINTE RECOVERY OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKHCHAKHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-414-9438
Mailing Address - Street 1:20335 VENTURA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20335 VENTURA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2451
Practice Address - Country:US
Practice Address - Phone:818-414-9438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health