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General NPI Number Information
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NPI Number | 1720594716
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Entity Type | Organization
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Legal Business Name | NEW LIFE SPIRIT, INC.
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 727 OWEN DR # ABC
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-2588
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Country | US
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Telephone | 949-721-1511
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Fax |
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Provider Business Mailing Address
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Address Line | 1053 GRANVILLE DR # CA
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-6205
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Country | US
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Telephone | 949-721-1511
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEVIN GARNER
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Credential | CATC, CDAC
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Telephone | 949-721-1511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number | 300671AP
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License Number State | CA
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