MEDICARE: TRUE LIFE RECOVERY, 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	324500000X	Substance Abuse Rehabilitation Facility	300631AP	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300631AP	OTHER	CA	CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES

General Provider Information

NPI Number	:	1922459551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE LIFE RECOVERY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 3097
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92659-0639
Country	:	US
Telephone Number	:	949-520-0530
Fax Number	:	949-271-4871

Provider Business Practice Location Address
First Line	:	16832 MAPLE ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-2227
Country	:	US
Telephone Number	:	949-520-0350
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	HAYDEN MOSER
Credential	:
Telephone Number	:	949-446-6281

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	07/20/2023

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