Provider Demographics
NPI:1770358293
Name:LA WELLNESS HAVEN
Entity type:Organization
Organization Name:LA WELLNESS HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HOVHANNES
Authorized Official - Middle Name:
Authorized Official - Last Name:SINANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-644-0826
Mailing Address - Street 1:8908 CANBY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2703
Mailing Address - Country:US
Mailing Address - Phone:818-644-0826
Mailing Address - Fax:
Practice Address - Street 1:8908 CANBY AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-2703
Practice Address - Country:US
Practice Address - Phone:818-644-0826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder