1366083362 NPI number — NEW ROAD RECOVERY SERVICES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366083362 NPI number — NEW ROAD RECOVERY SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ROAD RECOVERY SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEW ROAD RECOVERY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366083362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38832 FRUITRIDGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551-4633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-992-5114
Provider Business Mailing Address Fax Number:
661-948-4600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 LAKEVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551-7932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-992-5114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2019

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
SAMMY
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
661-992-5114

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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