Provider Demographics
NPI:1689797995
Name:NEW BEGINNINGS RECOVERY TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:NEW BEGINNINGS RECOVERY TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKOVENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-666-4082
Mailing Address - Street 1:5311 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-2703
Mailing Address - Country:US
Mailing Address - Phone:323-299-2111
Mailing Address - Fax:
Practice Address - Street 1:5311 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-2703
Practice Address - Country:US
Practice Address - Phone:323-299-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190337BN3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19713000OtherMEDI-CAL PROVIDER NUMBER