Provider Demographics
NPI:1912621129
Name:NORTHSTAR DETOX & REHAB CENTER, LLC
Entity Type:Organization
Organization Name:NORTHSTAR DETOX & REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-319-1133
Mailing Address - Street 1:4610 WINNETKA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4735
Mailing Address - Country:US
Mailing Address - Phone:818-928-2058
Mailing Address - Fax:
Practice Address - Street 1:4610 WINNETKA AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4735
Practice Address - Country:US
Practice Address - Phone:818-928-2058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORHTSTAR DETOX & REHAB CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility