Healthcare Provider Details

I. General information

NPI: 1881908010
Provider Name (Legal Business Name): LIFE CENTER FOR A NEW TOMORROW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SUNSHINE LN
WOODBURY TN
37190-4002
US

IV. Provider business mailing address

461 CEDAR CREST LN
WOODBURY TN
37190-6184
US

V. Phone/Fax

Practice location:
  • Phone: 615-563-4292
  • Fax: 615-563-4292
Mailing address:
  • Phone: 615-563-4292
  • Fax: 615-563-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number6994
License Number StateTN

VIII. Authorized Official

Name: MARC VALLIERES
Title or Position: OWNER/MANAGER
Credential:
Phone: 615-563-4292