NPIMap

Organization Active NPI

Vogue Recovery Center, LLC

  • Substance Abuse Rehabilitation Facility
  • Phoenix, AZ
National Provider Identifier
1417456336
Registry record updated Apr 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
BH5357 Issued in AZ
Legal business name
VOGUE RECOVERY CENTER, LLC
Practice address
4122 N 17TH St
Phoenix, AZ 85016-5922
Phone
(818) 916-8116
NPI assigned
Feb 6, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
George Boyadzhyan
Title
Ceo
Phone
(818) 916-8116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X BH5357 AZ Primary

Addresses

Primary practice location

4122 N 17TH St
Phoenix, AZ 85016-5922

Mailing address

16501 Sherman Way Ste 100
Van Nuys, CA 91406-3757

Other identifiers 1

IdentifierTypeStateIssuer
BH5357OtherAZARIZONA DEPARTMENT OF HEALTH SERVICES

National Provider Directory

National Provider Directory
Tax ID family
Vogue Recovery Center LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4122 N 17th St
Phoenix, AZ 85016
Phone (602) 265-4663

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523836800000",
    "number": "1417456336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16501 SHERMAN WAY STE 100",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914063757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4122 N 17TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165922",
            "telephone_number": "818-916-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VOGUE RECOVERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-06",
        "last_updated": "2018-04-16",
        "status": "A",
        "authorized_official_last_name": "BOYADZHYAN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-916-8116"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "BH5357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA DEPARTMENT OF HEALTH SERVICES",
            "identifier": "BH5357",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.