Provider Demographics
NPI:1720594716
Name:NEW LIFE SPIRIT, INC.
Entity Type:Organization
Organization Name:NEW LIFE SPIRIT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:CATC, CDAC
Authorized Official - Phone:949-721-1511
Mailing Address - Street 1:1053 GRANVILLE DR # CA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6205
Mailing Address - Country:US
Mailing Address - Phone:949-721-1511
Mailing Address - Fax:
Practice Address - Street 1:727 OWEN DR # ABC
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2588
Practice Address - Country:US
Practice Address - Phone:949-721-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300671AP276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit