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General NPI Number Information
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NPI Number | 1245580034
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Entity Type | Organization
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Legal Business Name | NEWPORT HARBOR RECOVERY
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 382 HAMILTON ST
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City | COSTA MESA
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State | CA
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Zip | 92627-2071
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Country | US
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Telephone | 949-645-5775
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Fax | 949-645-7222
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Provider Business Mailing Address
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Address Line | 2110 NEWPORT BLVD UNIT # 1
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City | COSTA MESA
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State | CA
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Zip | 92627-1781
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Country | US
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Telephone | 949-645-5775
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Fax | 949-645-7222
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DONALD D WARD
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Credential |
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Telephone | 94964557775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 300112BN
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License Number State | CA
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