Healthcare Provider Details

I. General information

NPI: 1356613616
Provider Name (Legal Business Name): NEW FOUND LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SE 2ND AVE SUITE 302
DELRAY BEACH FL
33444-3615
US

IV. Provider business mailing address

55 SE 2ND AVE SUITE 302
DELRAY BEACH FL
33444-3615
US

V. Phone/Fax

Practice location:
  • Phone: 561-715-6210
  • Fax: 772-619-8003
Mailing address:
  • Phone: 561-715-6210
  • Fax: 772-619-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number10D2040428
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL WATT
Title or Position: CEO
Credential:
Phone: 561-715-6210