MEDICARE: NEW CHANCE TREATMENT CENTER INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1508492562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW CHANCE TREATMENT CENTER INC.

Provider Business Mailing Address
First Line	:	7 NARBONNE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6823
Country	:	US
Telephone Number	:	626-644-0070
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 NARBONNE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6823
Country	:	US
Telephone Number	:	626-644-0070
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARY MALEK
Credential	:
Telephone Number	:	714-676-5400

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	03/20/2020

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