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Organization

NEW LIFE SPIRIT RECOVERY, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT TUCKER MCA, MRAS, MDAAC (CEO)
(714) 841-1906
Entity
Organization

Contact information

Practice address
18652 FLORIDA ST, SUITE 200, HUNTINGTON BEACH, CA 92648-1924
(714) 841-1906
(714) 908-3308
Mailing address
18652 FLORIDA ST, SUITE 200, HUNTINGTON BEACH, CA 92648-1924
(714) 841-1906
(714) 908-3308

Taxonomy

Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
300190AP
CA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
300190AP
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
300190AP
DHCS - DEPARTMENT OF HEALTH CARE SERVICES
CA
Enumeration date
03/04/2012
Last updated
01/20/2014
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