NPIMap

Organization Active NPI

New Life Health Authority

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Ukiah, CA
National Provider Identifier
1104435734
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
NEW LIFE HEALTH AUTHORITY
Practice address
280 E Standley St
Ukiah, CA 95482-4414
Phone
(707) 466-0001
Fax
(707) 466-0002
NPI assigned
Jul 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Louis Kershner
Title
Manager
Phone
(303) 859-2742

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

280 E Standley St
Ukiah, CA 95482-4414

Mailing address

280 E Standley St
Ukiah, CA 95482-4414
Phone (707) 466-0001

Other names 1

  • New Life LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Opioid treatment program
Medicare-enrolled since Aug 24, 2021

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211022001431 CA Part B Supplier - Opioid Treatment Program (Otp) 5799173837 Practice locations: Ukiah, CA

National Provider Directory

National Provider Directory
Tax ID family
New Life Health Authority2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

280 E Standley St
Ukiah, CA 95482
Phone (707) 466-0001

6650 Gunpark Dr
Ste 100
Boulder, CO 80301

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641340800000",
    "number": "1104435734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 E STANDLEY ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824414",
            "telephone_number": "707-466-0001",
            "fax_number": "707-466-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 E STANDLEY ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824414",
            "telephone_number": "707-466-0001",
            "fax_number": "707-466-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LIFE HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-29",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A",
        "authorized_official_last_name": "KERSHNER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "303-859-2742"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Life LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.