Provider Demographics
| NPI: | 1891539912 |
|---|---|
| Name: | NEW LIFE WELLNESS CENTER OF CA |
| Entity type: | Organization |
| Organization Name: | NEW LIFE WELLNESS CENTER OF CA |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | DAVID |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MOORE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 310-425-8433 |
| Mailing Address - Street 1: | 9663 SANTA MONICA BLVD # 730 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BEVERLY HILLS |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 90210-4303 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 3685 MOTOR AVE STE 150 |
| Practice Address - Street 2: | |
| Practice Address - City: | LOS ANGELES |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 90034-7203 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 310-425-8433 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-06-24 |
| Last Update Date: | 2024-06-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 251B00000X | Agencies | Case Management | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
| No | 261QM1100X | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient |
| No | 261QP2400X | Ambulatory Health Care Facilities | Clinic/Center | Prison Health |
| No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
| No | 276400000X | Hospital Units | Rehabilitation, Substance Use Disorder Unit | |
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) |
