MEDICARE: NU-WAY LIFE RECOVERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1497135495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NU-WAY LIFE RECOVERY CENTER

Provider Business Mailing Address
First Line	:	1905 S 25TH ST STE 103
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 S 25TH ST STE 103
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4739
Country	:	US
Telephone Number	:	772-577-7200
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DENNIS NYSTROM
Credential	:
Telephone Number	:	317-319-3132

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	07/27/2016

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Directions to “NU-WAY LIFE RECOVERY CENTER ” Practice Location

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