Healthcare Provider Details

I. General information

NPI: 1881482248
Provider Name (Legal Business Name): IOAN RECOVERY & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14536 ROSCOE BLVD STE 101
PANORAMA CITY CA
91402-4103
US

IV. Provider business mailing address

14536 ROSCOE BLVD STE 101
PANORAMA CITY CA
91402-4103
US

V. Phone/Fax

Practice location:
  • Phone: 818-539-7584
  • Fax:
Mailing address:
  • Phone: 818-539-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER EUGENE BASS
Title or Position: OWNER
Credential:
Phone: 818-814-9087