Healthcare Provider Details

I. General information

NPI: 1881822377
Provider Name (Legal Business Name): NEW BRANCHES 4 LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 18TH ST STE 522
BAKERSFIELD CA
93301-4443
US

IV. Provider business mailing address

1415 18TH ST STE 522
BAKERSFIELD CA
93301-4443
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-2732
  • Fax:
Mailing address:
  • Phone: 661-325-2732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH C JONES
Title or Position: SUPERVISOR
Credential:
Phone: 661-325-2732