Healthcare Provider Details

I. General information

NPI: 1689797995
Provider Name (Legal Business Name): NEW BEGINNINGS RECOVERY TREATMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 S WESTERN AVE
LOS ANGELES CA
90062-2703
US

IV. Provider business mailing address

5311 S WESTERN AVE
LOS ANGELES CA
90062-2703
US

V. Phone/Fax

Practice location:
  • Phone: 323-299-2111
  • Fax:
Mailing address:
  • Phone: 323-299-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number190337BN
License Number StateCA

VIII. Authorized Official

Name: MS. TATYANA YAKOVENKO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-666-4082