Provider Demographics
NPI:1063293454
Name:CALIFORNIA WELLNESS RETREAT, INC.
Entity type:Organization
Organization Name:CALIFORNIA WELLNESS RETREAT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VAHAGN
Authorized Official - Middle Name:
Authorized Official - Last Name:MKRTCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-666-6000
Mailing Address - Street 1:8131 ELLENBOGEN ST
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2103
Mailing Address - Country:US
Mailing Address - Phone:424-666-6000
Mailing Address - Fax:
Practice Address - Street 1:8131 ELLENBOGEN ST
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2103
Practice Address - Country:US
Practice Address - Phone:424-666-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder