MEDICARE: LIVE FREE RECOVERY CONSULTANTS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1770938482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE FREE RECOVERY CONSULTANTS

Provider Business Mailing Address
First Line	:	2 PUZZLE LN
Second Line	:	BLDG2 UNIT1
City	:	NEWTON
State	:	NH
Zip	:	03858-3721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 PUZZLE LN
Second Line	:	BLDG2 UNIT1
City	:	NEWTON
State	:	NH
Zip	:	03858-3721
Country	:	US
Telephone Number	:	603-702-2461
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT FAGHAN
Credential	:
Telephone Number	:	603-702-2461

Provider Enumeration Date	:	05/01/2016
Last Update Date	:	05/01/2016

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