Healthcare Provider Details

I. General information

NPI: 1073271011
Provider Name (Legal Business Name): NEW EXPERIENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17971 EUCLID ST
FOUNTAIN VALLEY CA
92708-5409
US

IV. Provider business mailing address

PO BOX 2498
COSTA MESA CA
92628-2498
US

V. Phone/Fax

Practice location:
  • Phone: 714-814-0272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: RYAN AIUMU
Title or Position: CEO
Credential:
Phone: 714-814-0272