Provider Demographics
NPI:1538923016
Name:CLEAR PATH IOP CENTER INC
Entity type:Organization
Organization Name:CLEAR PATH IOP CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOTELYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-477-4309
Mailing Address - Street 1:209 E ALAMEDA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2674
Mailing Address - Country:US
Mailing Address - Phone:747-477-4309
Mailing Address - Fax:
Practice Address - Street 1:209 E ALAMEDA AVE STE 100
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2674
Practice Address - Country:US
Practice Address - Phone:626-607-5964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder