Healthcare Provider Details

I. General information

NPI: 1841655388
Provider Name (Legal Business Name): NEW LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PEBBLE LN
POINT PLEASANT WV
25550-4236
US

IV. Provider business mailing address

PO BOX 470
POINT PLEASANT WV
25550-0470
US

V. Phone/Fax

Practice location:
  • Phone: 304-593-1369
  • Fax: 724-788-1243
Mailing address:
  • Phone: 304-593-1369
  • Fax: 724-788-1243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES TODD BOWEN
Title or Position: PRESIDENT
Credential:
Phone: 304-593-1369