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General NPI Number Information
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NPI Number | 1881482248
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Entity Type | Organization
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Legal Business Name | IOAN RECOVERY & WELLNESS CENTER
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 14536 ROSCOE BLVD STE 101
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City | PANORAMA CITY
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State | CA
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Zip | 91402-4103
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Country | US
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Telephone | 818-539-7584
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Fax |
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Provider Business Mailing Address
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Address Line | 14536 ROSCOE BLVD STE 101
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City | PANORAMA CITY
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State | CA
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Zip | 91402-4103
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Country | US
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Telephone | 818-539-7584
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRISTOPHER EUGENE BASS
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Credential |
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Telephone | 818-814-9087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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