Provider Demographics
NPI:1598293854
Name:NEW LIFE ADDICTION TREATMENT CENTER INC.
Entity Type:Organization
Organization Name:NEW LIFE ADDICTION TREATMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUILFOYLE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:714-492-9035
Mailing Address - Street 1:23785 EL TORO RD # 271
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4762
Mailing Address - Country:US
Mailing Address - Phone:714-492-9035
Mailing Address - Fax:949-407-4888
Practice Address - Street 1:24882 STEM AVE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5224
Practice Address - Country:US
Practice Address - Phone:714-492-9035
Practice Address - Fax:949-407-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300378AP101YA0400X, 101YM0800X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty