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NPI Code Detail

MEDICARE: NEW BEGINNINGS RECOVERY TREATMENT CENTER, INC.

MEDICARE: NEW BEGINNINGS RECOVERY TREATMENT CENTER, 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
13245S0500XChildren's Substance Abuse Rehabilitation Facility190337BNCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
119713000OTHERCAMEDI-CAL PROVIDER NUMBER

General Provider Information

NPI Number : 1689797995
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW BEGINNINGS RECOVERY TREATMENT CENTER, INC.
Provider Business Mailing Address
First Line : 5311 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90062-2703
Country : US
Telephone Number : 323-299-2111
Fax Number :
Provider Business Practice Location Address
First Line : 5311 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90062-2703
Country : US
Telephone Number : 323-299-2111
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. TATYANA YAKOVENKO
Credential :
Telephone Number : 310-666-4082
Provider Enumeration Date : 04/10/2007
Last Update Date : 08/22/2020

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