MEDICARE: NEW LIFE 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
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1750852703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE TREATMENT CENTER INC.

Provider Business Mailing Address
First Line	:	1940 EAST ORANGEWOOD AVENUE
Second Line	:	SUITE 205
City	:	ORANGE
State	:	CA
Zip	:	92868
Country	:	US
Telephone Number	:	626-644-0070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 W ORANGEWOOD AVE STE 204
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-2009
Country	:	US
Telephone Number	:	626-644-0070
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARY MALEK
Credential	:
Telephone Number	:	714-676-5400

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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