Healthcare Provider Details

I. General information

NPI: 1104246859
Provider Name (Legal Business Name): CONSCIOUS LIVING FOR BETTER LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 CASTLE CT
YOUNGSTOWN OH
44511-2979
US

IV. Provider business mailing address

3713 CASTLE CT
YOUNGSTOWN OH
44511-2979
US

V. Phone/Fax

Practice location:
  • Phone: 330-314-5193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BRANDALYN KEMP
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 330-314-3536