Provider Demographics
NPI:1356125447
Name:BELLAIRE RECOVERY, INC.
Entity type:Organization
Organization Name:BELLAIRE RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISHKHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHAZIYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-808-0108
Mailing Address - Street 1:6622 BELLAIRE AVE.
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606
Mailing Address - Country:US
Mailing Address - Phone:818-808-0108
Mailing Address - Fax:747-444-4085
Practice Address - Street 1:6622 BELLAIRE AVE.
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606
Practice Address - Country:US
Practice Address - Phone:818-808-0108
Practice Address - Fax:747-444-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder