Provider Demographics
NPI:1700691755
Name:YELLOW BRICK ROAD RECOVERY
Entity type:Organization
Organization Name:YELLOW BRICK ROAD RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AROUTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAGHOOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-707-5441
Mailing Address - Street 1:8201 GREENBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5514
Mailing Address - Country:US
Mailing Address - Phone:818-707-5441
Mailing Address - Fax:818-556-4750
Practice Address - Street 1:8201 GREENBUSH AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5514
Practice Address - Country:US
Practice Address - Phone:818-707-5441
Practice Address - Fax:818-556-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility