Provider Demographics
NPI:1124905658
Name:SHANTI RECOVERY & WELLNESS
Entity type:Organization
Organization Name:SHANTI RECOVERY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:URVI
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-944-1058
Mailing Address - Street 1:212 YACHT CLUB WAY STE A6
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 YACHT CLUB WAY STE A6
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6907
Practice Address - Country:US
Practice Address - Phone:310-620-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health