EXPERIENCE RECOVERY DETOX & RESIDENTIAL LLC. (NPI# 1316427446) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316427446 |
| Entity Type | Organization |
| Organization Name | EXPERIENCE RECOVERY DETOX & RESIDENTIAL LLC. |
| Practice Address |
3921 W Hazard Ave Santa Ana CA 92703-2625 |
| Mailing Address |
3919 W Hazard Ave Santa Ana CA 92703-2625 |
| Practice Telephone | 7147135272 |
| Mailing Telephone | 7148651052 |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2019-11-26 |
| Authorized Official Name | ANN PREMAZON (OWNER) |
| Authorized Official Telephone | 7148651052 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Experience Recovery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194250258 | Experience Recovery Detox & Residential LLC. | Substance Abuse Rehabilitation Facility | 3919 W Hazard Ave, Santa Ana, CA 92703-2625 | 2017-04-26 |
| Street Address |
3921 W HAZARD AVE |
| City | SANTA ANA |
| State | CA |
| Zip Code | 92703-2625 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316580806 | F Rodef & B Yousefi Dental Corporation | Dentist | 100 N. Harbor Blvd Suite #c-7, Santa Ana, CA 92703 | 2019-10-28 |
| 1699283465 | Vinnie Quan Nguyen | Pharmacist | 941 Fair Way, Santa Ana, CA 92703 | 2018-01-16 |
| 1174058978 | Caroline Jo Dimatteo | Physician Assistant | 901 W Civic Center Clinic, Ste 120, Santa Ana, CA 92703 | 2017-04-29 |
| 1568823342 | Reina M Escolero | Registered Nurse | 1708 W. 12th Street, Santa Ana, CA 92703 | 2016-03-08 |
| 1528427994 | Nathaniel Gandy Lane | Physician Assistant | 420 S. Bristol St., Santa Ana, CA 92703 | 2016-02-15 |
| 1285035626 | Elizabeth Nieto Patino | Specialist/Technologist | 4201 W 5th St #211, Santa Ana, CA 92703 | 2014-09-04 |
| 1790113108 | Monica Susie Kim | Acupuncturist | 100 N Harbor Blvd., Unit C-7, Santa Ana, CA 92703 | 2013-10-22 |
| 1730525833 | Ryan Hoida | Counselor | 1202 W Civic Dr, Santa Ana, CA 92703 | 2013-05-15 |
| 1861777625 | Minh Pharmacy | Pharmacy | 5110 Westminster Ave #b, Santa Ana, CA 92703 | 2011-10-12 |
| 1518241868 | James Shon | Acupuncturist | 1111 N. Bristol #j, Santa Ana, CA 92703 | 2011-10-05 |
| Find all providers in zip 92703 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538784319 | Clean Path Recovery, LLC | Substance Abuse Rehabilitation Facility | 929 S Townsend St, Santa Ana, CA 92704-2925 | 2020-06-08 |
| 1255961199 | Ca Ya Services Lls | Substance Abuse Rehabilitation Facility | 9951 Highcliff Dr, Santa Ana, CA 92705-1544 | 2020-01-20 |
| 1508428178 | Ca Ya Services LLC | Substance Abuse Rehabilitation Facility | 10022 Miramar Cir, Santa Ana, CA 92705-1502 | 2019-07-03 |
| 1124680921 | Ca Ya Services LLC | Substance Abuse Rehabilitation Facility | 9881 Deerhaven Dr, Santa Ana, CA 92705-7501 | 2019-07-01 |
| 1386118180 | Unified Behavioral Health, LLC | Substance Abuse Rehabilitation Facility | 1218 W Santa Ana Blvd, Santa Ana, CA 92705 | 2019-01-15 |
| 1508338096 | New Life Treatment Center Inc. | Substance Abuse Rehabilitation Facility | 335 E Adams St, Santa Ana, CA 92707-3509 | 2018-12-20 |
| 1104317940 | The Mend of California, LLC | Substance Abuse Rehabilitation Facility | 1909 W. Carlton Place, Santa Ana, CA 92704 | 2018-05-29 |
| 1073002523 | True Recovery Inc. | Substance Abuse Rehabilitation Facility | 902 W Alpine Ave, Santa Ana, CA 92707-3934 | 2018-05-09 |
| 1962999052 | Guardian Health Care Services | Substance Abuse Rehabilitation Facility | 2902 S Rene Dr, Santa Ana, CA 92704-6222 | 2018-04-16 |
| 1578063004 | Beachside Recovery LLC | Substance Abuse Rehabilitation Facility | 1340 N Custer St, Santa Ana, CA 92701-2506 | 2018-02-21 |
| Find all providers in SANTA ANA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.