Organization
NEW LIFE TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL THACKER (EXECUTIVE DIRECTOR)
(507) 777-4321
Entity
Organization
Contact information
Practice address
130 DAKOTA ST, WOODSTOCK, MN 56186
(507) 777-4321
(507) 777-4284
Mailing address
130 DAKOTA ST S, WOODSTOCK, MN 56186-1037
(507) 777-4321
(507) 777-4284
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
363A00000X
Physician Assistant
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
12/21/2016
Last updated
12/21/2016
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