Healthcare Provider Details

I. General information

NPI: 1912466459
Provider Name (Legal Business Name): NEW LIFE MEDICAL DETOXIFICATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 ROUTE 70 EAST SUITE E100
MARLTON NJ
08053-4128
US

IV. Provider business mailing address

773 ROUTE 70 EAST SUITE E100
MARLTON NJ
08053-4128
US

V. Phone/Fax

Practice location:
  • Phone: 856-942-3700
  • Fax:
Mailing address:
  • Phone: 856-942-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSEPH J SAVON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 609-668-2503