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General NPI Number Information
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NPI Number | 1659070555
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Entity Type | Organization
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Legal Business Name | BACK TO LIFE RECOVERY, LLC
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 630 CLEMENTS BRIDGE RD
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City | BARRINGTON
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State | NJ
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Zip | 08007-1814
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Country | US
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Telephone | 856-547-1107
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Fax |
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Provider Business Mailing Address
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Address Line | 630 CLEMENTS BRIDGE RD
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City | BARRINGTON
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State | NJ
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Zip | 08007-1814
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Country | US
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Telephone | 609-228-8667
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARK FRANCIS WERNER
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Credential |
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Telephone | 215-370-3646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health 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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