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General NPI Number Information
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NPI Number | 1538782198
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Entity Type | Organization
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Legal Business Name | ASANA RECOVERY
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 3062 JOHNSON AVE
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City | COSTA MESA
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State | CA
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Zip | 92626-2819
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Country | US
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Telephone | 702-786-2396
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Fax |
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Provider Business Mailing Address
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Address Line | 1730 POMONA AVE STE 3
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City | COSTA MESA
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State | CA
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Zip | 92627-3628
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Country | US
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Telephone | 310-999-2242
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARK SHANDROW
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Credential |
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Telephone | 702-786-2396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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