Provider Demographics
NPI:1730722828
Name:NOVA VITAE RECOVERY CENTER
Entity type:Organization
Organization Name:NOVA VITAE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YADEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-422-3442
Mailing Address - Street 1:4942 VINELAND AVE STE R
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-5637
Mailing Address - Country:US
Mailing Address - Phone:818-422-3442
Mailing Address - Fax:818-647-6500
Practice Address - Street 1:5985 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3623
Practice Address - Country:US
Practice Address - Phone:818-925-5985
Practice Address - Fax:818-647-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility