Organization
LIFE TREATMENT CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID NOWAK MSBA,MBA,PHR (CEO)
(574) 233-5433
Entity
Organization
Contact information
Practice address
1402 S MICHIGAN ST, SOUTH BEND, IN 46613-2214
(574) 233-5433
(574) 239-6407
Mailing address
1402 S MICHIGAN ST, SOUTH BEND, IN 46613-2214
(574) 233-5433
(574) 239-6407
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
806-0-ASR
IN
Other
Enumeration date
06/16/2011
Last updated
06/16/2011
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