Provider Demographics
NPI:1215436605
Name:VOGUE RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:VOGUE RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYADZHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-916-8116
Mailing Address - Street 1:6655 W SAHARA AVE STE D208
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0851
Mailing Address - Country:US
Mailing Address - Phone:818-916-8116
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE STE D208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0851
Practice Address - Country:US
Practice Address - Phone:818-916-8116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8779-ADA-0OtherNEVADA DHS LICENSE