Provider Demographics
NPI:1871162776
Name:NEW LIFE RECOVERY CENTER LLC
Entity type:Organization
Organization Name:NEW LIFE RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-668-0092
Mailing Address - Street 1:25 N WENATCHEE AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2283
Mailing Address - Country:US
Mailing Address - Phone:253-528-6091
Mailing Address - Fax:
Practice Address - Street 1:25 N WENATCHEE AVE STE 214
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2283
Practice Address - Country:US
Practice Address - Phone:509-669-9582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604768996OtherUBI