Healthcare Provider Details

I. General information

NPI: 1952062572
Provider Name (Legal Business Name): NEW VISION RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 W MAIN ST
WEST LIBERTY KY
41472-2012
US

IV. Provider business mailing address

1390 W MAIN ST
WEST LIBERTY KY
41472-2012
US

V. Phone/Fax

Practice location:
  • Phone: 606-359-3114
  • Fax:
Mailing address:
  • Phone: 606-359-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMANDA NICHOLS
Title or Position: OWNER
Credential: MSW
Phone: 606-359-3114