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General NPI Number Information
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NPI Number | 1497135495
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Entity Type | Organization
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Legal Business Name | NU-WAY LIFE RECOVERY CENTER
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 1905 S 25TH ST STE 103
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City | FORT PIERCE
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State | FL
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Zip | 34947-4739
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Country | US
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Telephone | 772-577-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 S 25TH ST STE 103
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City | FORT PIERCE
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State | FL
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Zip | 34947-4739
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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 | CEO
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Name | DENNIS NYSTROM
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Credential |
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Telephone | 317-319-3132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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