Provider Demographics
NPI:1255736542
Name:A NEW START
Entity type:Organization
Organization Name:A NEW START
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO AND ASSISTANCE TO THE CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORRECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-773-4477
Mailing Address - Street 1:3151 AIRWAY AVE STE E1
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4620
Mailing Address - Country:US
Mailing Address - Phone:888-700-5053
Mailing Address - Fax:805-556-4733
Practice Address - Street 1:11243 LUCERNE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90230-5207
Practice Address - Country:US
Practice Address - Phone:805-644-1598
Practice Address - Fax:805-556-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190798CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility