MEDICARE: HEALING PATH RECOVERY A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1093130601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING PATH RECOVERY A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	366 SAN MIGUEL DR STE 310
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7810
Country	:	US
Telephone Number	:	949-706-5215
Fax Number	:

Provider Business Practice Location Address
First Line	:	366 SAN MIGUEL DR STE 310
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7810
Country	:	US
Telephone Number	:	949-706-5215
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. ALI BEHESHTI
Credential	:
Telephone Number	:	619-929-7956

Provider Enumeration Date	:	02/19/2014
Last Update Date	:	02/19/2014

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