Basic Information
| Provider Information | |||||||||
| NPI: | 1205969441 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW LIFE HOME FOR RECOVERING WOMEN, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17131 GITRE ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482053161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132454357 | ||||||||
| FaxNumber: | 3133716139 | ||||||||
| Practice Location | |||||||||
| Address1: | 17131 GITRE ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482053161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132454357 | ||||||||
| FaxNumber: | 3133716139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HORNBUCKLE | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | DIANE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRCTOR | ||||||||
| AuthorizedOfficialTelephone: | 3132454357 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | B.S., MPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.