Healthcare Provider Details

I. General information

NPI: 1043806524
Provider Name (Legal Business Name): NEW CHANCE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 VALLEY BLVD STE A
WALNUT CA
91789-1531
US

IV. Provider business mailing address

3990 VALLEY BLVD STE A
WALNUT CA
91789-1531
US

V. Phone/Fax

Practice location:
  • Phone: 626-533-3309
  • Fax:
Mailing address:
  • Phone: 626-533-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRITTANY J ROBERTS-PRICE
Title or Position: CEO
Credential:
Phone: 626-533-3309