Provider Demographics
NPI:1447705538
Name:NEW LIFE REHAB AND ACUPUNCTURE, INC
Entity type:Organization
Organization Name:NEW LIFE REHAB AND ACUPUNCTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:BENZ
Authorized Official - Last Name:TRINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-701-4349
Mailing Address - Street 1:9161 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-4729
Mailing Address - Country:US
Mailing Address - Phone:909-428-6882
Mailing Address - Fax:
Practice Address - Street 1:9161 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4729
Practice Address - Country:US
Practice Address - Phone:909-428-6882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA053961261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)