Provider Demographics
NPI:1477576684
Name:NEW LIFE CENTERS, LLC
Entity Type:Organization
Organization Name:NEW LIFE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:801-281-3353
Mailing Address - Street 1:1255 E 3900 S STE 300
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1389
Mailing Address - Country:US
Mailing Address - Phone:801-281-3353
Mailing Address - Fax:801-281-3373
Practice Address - Street 1:1255 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1334
Practice Address - Country:US
Practice Address - Phone:801-281-3353
Practice Address - Fax:801-281-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11489320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11489OtherSTATE LICENSE NUMBER