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General NPI Number Information
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NPI Number | 1245935576
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Entity Type | Organization
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Legal Business Name | NEW LIFE RECOVERY SERVICES
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Dates
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Enumeration Date | 04/04/2023
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 2410 GRAND BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-4630
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Country | US
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Telephone | 360-729-7037
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2275
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City | VANCOUVER
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State | WA
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Zip | 98668-2275
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Country | US
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Telephone | 360-729-7037
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CARL ALBERT ROBINSON
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Credential | SUDP, MSW
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Telephone | 360-729-7037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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