Provider Demographics
NPI:1689729444
Name:NEW LIFE RECOVERY CENTER,INC
Entity Type:Organization
Organization Name:NEW LIFE RECOVERY CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:973-728-7788
Mailing Address - Street 1:23 COLFAX AVENUE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1709
Mailing Address - Country:US
Mailing Address - Phone:973-728-7788
Mailing Address - Fax:973-728-7410
Practice Address - Street 1:23 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1709
Practice Address - Country:US
Practice Address - Phone:973-728-7788
Practice Address - Fax:973-728-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22773261QR0405X
276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8078700Medicaid