Healthcare Provider Details

I. General information

NPI: 1578626537
Provider Name (Legal Business Name): FAMILY NEW LIFE REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 KILPATRICK BLVD STE 100
MONROE LA
71201-5156
US

IV. Provider business mailing address

3100 KILPATRICK BLVD STE 100
MONROE LA
71201-5156
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-8050
  • Fax: 318-325-5385
Mailing address:
  • Phone: 318-325-8050
  • Fax: 318-325-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number10067
License Number StateLA

VIII. Authorized Official

Name: MRS. ADRIAN WILLIAMS
Title or Position: PROGRAM DIRECTOR
Credential: LCSW
Phone: 318-325-8050