=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265818082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEST NEW LIFE RECOVERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2015
-----------------------------------------------------
Last Update Date | 11/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20755 CARANCHO RD
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92590-4242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-545-4606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25060 HANCOCK AVE SUITE #103-106
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-5930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-545-4606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BROOKE ELIZABETH BEST-FREEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-545-4606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 330137AP
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 330137BP
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------