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General NPI Number Information
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NPI Number | 1093336422
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Entity Type | Organization
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Legal Business Name | NEW LIFE RECOVERY CENTER LLC
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 102 SAINT PAUL ST
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City | BALTIMORE
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State | MD
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Zip | 21202-1704
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Country | US
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Telephone | 410-878-0032
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Fax |
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Provider Business Mailing Address
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Address Line | 302 PARK AVE
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City | BALTIMORE
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State | MD
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Zip | 21201-3618
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Country | US
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Telephone | 410-878-0032
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. VENNIETH L. MCCORMICK
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Credential |
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Telephone | 410-908-3106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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