Provider Demographics
NPI:1902551476
Name:AMERICAN INSTITUTE OF ADDICTION
Entity type:Organization
Organization Name:AMERICAN INSTITUTE OF ADDICTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKITARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-800-4734
Mailing Address - Street 1:12400 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2415
Mailing Address - Country:US
Mailing Address - Phone:818-232-7220
Mailing Address - Fax:818-217-1224
Practice Address - Street 1:12400 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2415
Practice Address - Country:US
Practice Address - Phone:818-232-7220
Practice Address - Fax:818-217-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility