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General NPI Number Information
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NPI Number | 1356613616
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Entity Type | Organization
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Legal Business Name | NEW FOUND LIFE
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 55 SE 2ND AVE SUITE 302
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City | DELRAY BEACH
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State | FL
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Zip | 33444-3615
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Country | US
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Telephone | 561-715-6210
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Fax | 772-619-8003
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Provider Business Mailing Address
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Address Line | 55 SE 2ND AVE SUITE 302
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City | DELRAY BEACH
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State | FL
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Zip | 33444-3615
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Country | US
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Telephone | 561-715-6210
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Fax | 772-619-8003
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL WATT
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Credential |
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Telephone | 561-715-6210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D2040428
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License Number State | FL
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Taxonomy #2
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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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