Provider Demographics
NPI:1528564358
Name:NEW LIFE BEHAVIORAL AND YOUTH DEVELOPMENT LLC
Entity Type:Organization
Organization Name:NEW LIFE BEHAVIORAL AND YOUTH DEVELOPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ELEAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-600-3962
Mailing Address - Street 1:201 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-2067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2067
Practice Address - Country:US
Practice Address - Phone:318-816-5514
Practice Address - Fax:318-816-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X
LABH0012306251S00000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health