Provider Demographics
NPI:1417847278
Name:COLFAX RECOVERY
Entity type:Organization
Organization Name:COLFAX RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELUMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-319-6463
Mailing Address - Street 1:4812 COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4306
Mailing Address - Country:US
Mailing Address - Phone:818-319-6463
Mailing Address - Fax:
Practice Address - Street 1:4812 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4306
Practice Address - Country:US
Practice Address - Phone:818-319-6463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder