Provider Demographics
NPI:1588024509
Name:CALIFORNIA NEW LIFE DETOX AND RECOVERY HOMES, INC.
Entity Type:Organization
Organization Name:CALIFORNIA NEW LIFE DETOX AND RECOVERY HOMES, INC.
Other - Org Name:CALIFORNIA NEW LIFE DETOX AND RECOVERY HOMES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEBOBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:181-775-9431
Mailing Address - Street 1:9529 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2120
Mailing Address - Country:US
Mailing Address - Phone:818-775-9431
Mailing Address - Fax:818-626-9749
Practice Address - Street 1:9529 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2120
Practice Address - Country:US
Practice Address - Phone:818-775-9431
Practice Address - Fax:818-626-9749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA NEW LIFE DETOX AND RECOVERY HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190851BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190851BPOtherDHCS. STATE LICENSE NUMBER 190851BP