Healthcare Provider Details

I. General information

NPI: 1285836924
Provider Name (Legal Business Name): NEW BRANCHES 4 LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 18TH ST #522
BAKERSFIELD CA
93301-4430
US

IV. Provider business mailing address

1415 18TH ST #522
BAKERSFIELD CA
93301-4430
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-2732
  • Fax: 661-325-2101
Mailing address:
  • Phone: 661-325-2732
  • Fax: 661-325-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number150034AP
License Number StateCA

VIII. Authorized Official

Name: MR. JOSEPH CRAWFORD JONES JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 661-325-2732