Provider Demographics
NPI:1134596356
Name:CALIFORNIA NEW LIFE DETOX AND RECOVERY HOMES, INC.
Entity type:Organization
Organization Name:CALIFORNIA NEW LIFE DETOX AND RECOVERY HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEBABOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-775-1749
Mailing Address - Street 1:18134 CHASE STREET
Mailing Address - Street 2:CHASE STREET
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:818-775-1749
Mailing Address - Fax:818-626-9749
Practice Address - Street 1:18134 CHASE ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3730
Practice Address - Country:US
Practice Address - Phone:818-775-1749
Practice Address - Fax:818-626-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190851AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility