MEDICARE: NEW CHOICES RECOVERY CENTERS INC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1396161642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW CHOICES RECOVERY CENTERS INC

Provider Business Mailing Address
First Line	:	5125 HERSHOLT AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2730
Country	:	US
Telephone Number	:	562-316-8184
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 WALNUT AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-5033
Country	:	US
Telephone Number	:	562-316-8184
Fax Number	:

Authorized Official
Title or Position	:	CO-PRESIDENT
Name	:	MR. MATTHEW H COOPER
Credential	:
Telephone Number	:	562-316-8184

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	03/11/2014

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