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NPI Code Detail

MEDICARE: NEW LIFE BEHAVIORAL AND YOUTH DEVELOPMENT LLC

MEDICARE: NEW LIFE BEHAVIORAL AND YOUTH DEVELOPMENT LLC
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
1251S00000XCommunity/Behavioral Health AgencyLA
2251S00000XCommunity/Behavioral Health AgencyBH0012306LA
3324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1528564358
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW LIFE BEHAVIORAL AND YOUTH DEVELOPMENT LLC
Provider Business Mailing Address
First Line : 201 MORRIS AVE
Second Line :
City : MONROE
State : LA
Zip : 71202-2067
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 MORRIS AVE
Second Line :
City : MONROE
State : LA
Zip : 71202-2067
Country : US
Telephone Number : 318-816-5514
Fax Number : 318-816-5514
Authorized Official
Title or Position : OWNER
Name : MR. MARK ANTHONY ELEAM
Credential :
Telephone Number : 318-600-3962
Provider Enumeration Date : 04/02/2018
Last Update Date : 08/23/2021

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Directions to “NEW LIFE BEHAVIORAL AND YOUTH DEVELOPMENT LLC ” Practice Location

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