Provider Demographics
NPI:1245580034
Name:NEWPORT HARBOR RECOVERY
Entity Type:Organization
Organization Name:NEWPORT HARBOR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9496-455-7775
Mailing Address - Street 1:2110 NEWPORT BLVD
Mailing Address - Street 2:UNIT # 1
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1781
Mailing Address - Country:US
Mailing Address - Phone:949-645-5775
Mailing Address - Fax:949-645-7222
Practice Address - Street 1:382 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2071
Practice Address - Country:US
Practice Address - Phone:949-645-5775
Practice Address - Fax:949-645-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300112BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility