Healthcare Provider Details

I. General information

NPI: 1134039142
Provider Name (Legal Business Name): OMNIA RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 E THOUSAND OAKS BLVD STE F
THOUSAND OAKS CA
91362-6216
US

IV. Provider business mailing address

1459 E THOUSAND OAKS BLVD STE D
THOUSAND OAKS CA
91362-6221
US

V. Phone/Fax

Practice location:
  • Phone: 805-744-7522
  • Fax: 805-855-4099
Mailing address:
  • Phone: 805-744-7522
  • Fax: 805-855-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAN JOHNSONAVANESZADEH
Title or Position: CEO
Credential:
Phone: 805-744-7522