Provider Demographics
NPI:1063962660
Name:RENEWAL SOBRIETY
Entity type:Organization
Organization Name:RENEWAL SOBRIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MORDECHI
Authorized Official - Middle Name:DOVID
Authorized Official - Last Name:OSIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-684-7089
Mailing Address - Street 1:4931 BLUEBELL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6442 COLDWATER CANYON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1137
Practice Address - Country:US
Practice Address - Phone:323-684-7089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder