Provider Demographics
NPI:1437444692
Name:LIFE TREATMENT CENTERS
Entity Type:Organization
Organization Name:LIFE TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MSBA,MBA,PHR
Authorized Official - Phone:574-233-5433
Mailing Address - Street 1:1402 S MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46613-2214
Mailing Address - Country:US
Mailing Address - Phone:574-233-5433
Mailing Address - Fax:574-239-6407
Practice Address - Street 1:1402 S MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-2214
Practice Address - Country:US
Practice Address - Phone:574-233-5433
Practice Address - Fax:574-239-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN806-0-ASR324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility