Provider Demographics
NPI:1437827243
Name:ASANA RECOVERY
Entity Type:Organization
Organization Name:ASANA RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANDROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-999-2242
Mailing Address - Street 1:1730 POMONA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3628
Mailing Address - Country:US
Mailing Address - Phone:310-999-2242
Mailing Address - Fax:
Practice Address - Street 1:18101 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5647
Practice Address - Country:US
Practice Address - Phone:310-999-2242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-06
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility