Organization Name: | RE-NEW LIFE |
NPI Number: | 1740486711 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLES P NEELY (CEO) |
Mailing Address: | 33204 E. R.d. Mize Road Grain Valley |
State: | MO US |
Postal Code: | 64029 |
Phone Number: | 8164433311 |
Fax Number: | 8164433311 |
NPI Enumeration Date: | 06/26/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |