Provider Demographics
NPI:1730277922
Name:NEWPORT HEALTH NETWORK INC
Entity type:Organization
Organization Name:NEWPORT HEALTH NETWORK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:MABB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-385-3761
Mailing Address - Street 1:FILE 50255
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0255
Mailing Address - Country:US
Mailing Address - Phone:800-675-5484
Mailing Address - Fax:720-385-3770
Practice Address - Street 1:5990 GREENWOOD PLAZA BLVD
Practice Address - Street 2:STE# 120
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4704
Practice Address - Country:US
Practice Address - Phone:800-675-5485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000370Medicaid