Provider Demographics
NPI:1679306658
Name:SPERO DETOX CENTER
Entity type:Organization
Organization Name:SPERO DETOX CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MHER
Authorized Official - Middle Name:
Authorized Official - Last Name:AVETYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-220-8022
Mailing Address - Street 1:18923 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1146
Mailing Address - Country:US
Mailing Address - Phone:818-220-8022
Mailing Address - Fax:
Practice Address - Street 1:18923 WILLARD ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1146
Practice Address - Country:US
Practice Address - Phone:818-220-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder