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General NPI Number Information
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NPI Number | 1477769446
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Entity Type | Organization
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Legal Business Name | ELIZABETH'S NEW LIFE CENTER
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 359 FOREST AVE SUITE 203
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City | DAYTON
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State | OH
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Zip | 45405-4563
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Country | US
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Telephone | 937-226-7414
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Fax |
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Provider Business Mailing Address
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Address Line | 359 FOREST AVE SUITE 203
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City | DAYTON
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State | OH
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Zip | 45405-4563
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Country | US
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Telephone | 937-226-7414
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ANN T MOELL
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Credential | M.D.
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Telephone | 937-226-7414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State | OH
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