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General NPI Number Information
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NPI Number | 1104246859
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Entity Type | Organization
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Legal Business Name | CONSCIOUS LIVING FOR BETTER LIVING
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 3713 CASTLE CT
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City | YOUNGSTOWN
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State | OH
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Zip | 44511-2979
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Country | US
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Telephone | 330-314-5193
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Fax |
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Provider Business Mailing Address
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Address Line | 3713 CASTLE CT
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City | YOUNGSTOWN
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State | OH
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Zip | 44511-2979
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BRANDALYN KEMP
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Credential |
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Telephone | 330-314-3536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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