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General NPI Number Information
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NPI Number | 1912136144
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Entity Type | Organization
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Legal Business Name | NEW LIFE CHILDREN'S HOME
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 50 4TH ST
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City | OIL TROUGH
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State | AR
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Zip | 72564
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Country | US
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Telephone | 870-264-3757
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Fax | 870-264-9300
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Provider Business Mailing Address
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Address Line | PO BOX 885
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City | NEWPORT
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State | AR
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Zip | 72112-0885
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Country | US
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Telephone | 870-264-3757
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Fax | 870-264-9300
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PAMELA MARIE WHITAKER
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Credential | LMSW
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Telephone | 870-217-9125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 20128
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License Number State | AR
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