Healthcare Provider Details

I. General information

NPI: 1477576684
Provider Name (Legal Business Name): NEW LIFE CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 E 3900 S
SALT LAKE CITY UT
84124-1334
US

IV. Provider business mailing address

1255 E 3900 S STE 300
SALT LAKE CITY UT
84124-1389
US

V. Phone/Fax

Practice location:
  • Phone: 801-281-3353
  • Fax: 801-281-3373
Mailing address:
  • Phone: 801-281-3353
  • Fax: 801-281-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number11489
License Number StateUT

VIII. Authorized Official

Name: MS. ALYSON HARDING
Title or Position: EXECUTIVE VICE PRESIDENT
Credential: MS
Phone: 801-281-3353