Provider Demographics
NPI:1770126849
Name:VOGUE RECOVERY CALIFORNIA, LLC
Entity type:Organization
Organization Name:VOGUE RECOVERY CALIFORNIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEVORK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYADZHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-916-8116
Mailing Address - Street 1:16501 SHERMAN WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3757
Mailing Address - Country:US
Mailing Address - Phone:818-304-8071
Mailing Address - Fax:818-374-1385
Practice Address - Street 1:4960 VANALDEN AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4718
Practice Address - Country:US
Practice Address - Phone:818-881-8944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility