Provider Demographics
NPI:1598500852
Name:4 HEALTHY LIVING DETOX INC
Entity type:Organization
Organization Name:4 HEALTHY LIVING DETOX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEHRIBARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-216-3755
Mailing Address - Street 1:4451 LA BARCA DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-5042
Mailing Address - Country:US
Mailing Address - Phone:424-444-3553
Mailing Address - Fax:
Practice Address - Street 1:4451 LA BARCA DR
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-5042
Practice Address - Country:US
Practice Address - Phone:424-444-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility