Provider Demographics
NPI:1912442500
Name:A NEW START TREATMENT AND RECOVERY - MILTON
Entity type:Organization
Organization Name:A NEW START TREATMENT AND RECOVERY - MILTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPECIAL 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:
Practice Address - Street 1:4111 MILTON AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-4054
Practice Address - Country:US
Practice Address - Phone:310-287-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A NEW START TREATMENT AND RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-05
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190798DP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility