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General NPI Number Information
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NPI Number | 1437249869
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Entity Type | Organization
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Legal Business Name | NEW LIFE ADDICTION COUNSELING SERVICES INC
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Dates
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Enumeration Date | 10/14/2006
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 7240 PARKWAY DR STE 140
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City | HANOVER
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State | MD
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Zip | 21076-1367
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Country | US
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Telephone | 714-828-1800
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Fax | 714-882-1186
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Provider Business Mailing Address
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Address Line | 18401 VON KARMAN AVE STE 500
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City | IRVINE
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State | CA
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Zip | 92612-8531
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Country | US
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Telephone | 714-828-1800
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Fax | 714-882-1186
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Authorized Official
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Title or Position | DIRECTOR OF PAYER RELATIONS
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Name | MAGDALEN GUSTILO
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Credential |
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Telephone | 714-568-7667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | D0018051
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License Number State | MD
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