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General NPI Number Information
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NPI Number | 1275497174
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Entity Type | Organization
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Legal Business Name | LIVE FREE ADOLESCENT RECOVERY LLC
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 74 SOUTH MAIN ST
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City | NEWTON
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State | NH
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Zip | 03858
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Country | US
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Telephone | 603-702-2461
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 48
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City | NEWTON
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State | NH
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Zip | 03858-0048
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Country | US
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Telephone | 603-702-2461
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | ROBERT FAGHAN
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Credential | MLADC
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Telephone | 603-702-2461
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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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