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General NPI Number Information
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NPI Number | 1396247003
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Entity Type | Organization
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Legal Business Name | NEW EXISTENCE
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 3073 MADISON AVE
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City | COSTA MESA
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State | CA
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Zip | 92626-2823
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Country | US
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Telephone | 253-653-2243
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2320
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City | COSTA MESA
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State | CA
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Zip | 92628-2320
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Country | US
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Telephone | 253-653-2243
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DYLAN WALKER
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Credential |
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Telephone | 253-653-2243
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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 | 300384BP
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License Number State | CA
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