Healthcare Provider Details

I. General information

NPI: 1316354574
Provider Name (Legal Business Name): NEW LIFECLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3471 OHIO RIVER RD
POINT PLEASANT WV
25550-4401
US

IV. Provider business mailing address

PO BOX 457
BEAVER PA
15009-0457
US

V. Phone/Fax

Practice location:
  • Phone: 304-812-5965
  • Fax:
Mailing address:
  • Phone: 724-513-4881
  • Fax: 724-385-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES TODD BOWEN
Title or Position: OWNER
Credential:
Phone: 724-513-4881