| New Life Su - Banning Probation | |
|
135 N Alessandro St Banning CA 92220-5545 | |
| (951) 955-1503 | |
| Not Available |
| Full Name | New Life Su - Banning Probation |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 135 N Alessandro St, Banning, California |
| Authorized Official Name and Position | Jerry Wengerd (DIRECTOR OF MENTAL HEALTH) |
| Authorized Official Contact | 9513584500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| New Life Su - Banning Probation 4095 County Circle Dr Riverside CA 92503-3410 Ph: (951) 358-6900 | New Life Su - Banning Probation 135 N Alessandro St Banning CA 92220-5545 Ph: (951) 955-1503 |
| NPI Number | 1316318967 |
|---|---|
| Provider Enumeration Date | 10/08/2015 |
| Last Update Date | 10/08/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316318967 | NPI | - | NPPES |
| 33 | Other | CA | COUNTY CODE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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