Provider Demographics
NPI:1013543982
Name:NEW LIFE RECOVERY, LLC
Entity Type:Organization
Organization Name:NEW LIFE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC III
Authorized Official - Phone:740-302-2218
Mailing Address - Street 1:425 MARION PIKE
Mailing Address - Street 2:
Mailing Address - City:COAL GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2960
Mailing Address - Country:US
Mailing Address - Phone:740-377-1998
Mailing Address - Fax:
Practice Address - Street 1:425 MARION PIKE
Practice Address - Street 2:
Practice Address - City:COAL GROVE
Practice Address - State:OH
Practice Address - Zip Code:45638-2960
Practice Address - Country:US
Practice Address - Phone:740-377-1998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility