Provider Demographics
NPI:1245121805
Name:ADVANCE LIFE RECOVERY
Entity type:Organization
Organization Name:ADVANCE LIFE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KSACHIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-929-2891
Mailing Address - Street 1:9350 TAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2744
Mailing Address - Country:US
Mailing Address - Phone:888-929-2891
Mailing Address - Fax:818-483-9859
Practice Address - Street 1:9350 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2744
Practice Address - Country:US
Practice Address - Phone:888-929-2891
Practice Address - Fax:818-483-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility