Healthcare Provider Details

I. General information

NPI: 1417531237
Provider Name (Legal Business Name): INDAH RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35492 DEL REY
DANA POINT CA
92624-1836
US

IV. Provider business mailing address

5825 LINCOLN AVE STE D-613
BUENA PARK CA
90620-3463
US

V. Phone/Fax

Practice location:
  • Phone: 818-294-5019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DANNY RIZKALLAH
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 818-294-5019