MEDICARE: OMNIA RECOVERY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	106H00000X	Marriage & Family Therapist
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
6	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1962111690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNIA RECOVERY INC

Provider Business Mailing Address
First Line	:	5515 CANOGA AVE APT 321
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6631
Country	:	US
Telephone Number	:	213-509-5190
Fax Number	:

Provider Business Practice Location Address
First Line	:	1459 E THOUSAND OAKS BLVD STE D
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-6221
Country	:	US
Telephone Number	:	213-509-5190
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALAN JOHNSONAVANESZADEH
Credential	:
Telephone Number	:	213-509-5190

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	12/08/2022

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