Organization
NU-WAY LIFE RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS NYSTROM (CEO)
(317) 319-3132
Entity
Organization
Contact information
Practice address
1905 S 25TH ST STE 103, FORT PIERCE, FL 34947-4739
(772) 577-7200
Mailing address
1905 S 25TH ST STE 103, FORT PIERCE, FL 34947-4739
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
06/04/2015
Last updated
07/27/2016
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