Healthcare Provider Details

I. General information

NPI: 1275497174
Provider Name (Legal Business Name): LIVE FREE ADOLESCENT RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 SOUTH MAIN ST
NEWTON NH
03858
US

IV. Provider business mailing address

PO BOX 48
NEWTON NH
03858-0048
US

V. Phone/Fax

Practice location:
  • Phone: 603-702-2461
  • Fax:
Mailing address:
  • Phone: 603-702-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FAGHAN
Title or Position: PROGRAM DIRECTOR
Credential: MLADC
Phone: 603-702-2461