Healthcare Provider Details

I. General information

NPI: 1477017259
Provider Name (Legal Business Name): NEW ROAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W MAGNOLIA BLVD
BURBANK CA
91506-1727
US

IV. Provider business mailing address

1901 W MAGNOLIA BLVD
BURBANK CA
91506-1727
US

V. Phone/Fax

Practice location:
  • Phone: 424-600-0001
  • Fax:
Mailing address:
  • Phone: 424-600-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: LILIT MURYADYAN
Title or Position: CEO
Credential:
Phone: 424-600-0001