Provider Demographics
NPI:1417582370
Name:NEW ESSENCE RECOVERY
Entity Type:Organization
Organization Name:NEW ESSENCE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:INDIGO
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:ALLENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:RADT1
Authorized Official - Phone:949-335-8802
Mailing Address - Street 1:3140 RED HILL AVE STE 284
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3400
Mailing Address - Country:US
Mailing Address - Phone:949-335-8802
Mailing Address - Fax:
Practice Address - Street 1:10784 HARCOURT AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-6341
Practice Address - Country:US
Practice Address - Phone:949-335-8802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346387743Other300670AP
CA300670APOtherLICENSE #