Organization
NEW LIFE RECOVERY CLINIC 2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AKARI TICHAVAKUNDA MD (OWNER)
(216) 770-3130
Entity
Organization
Contact information
Practice address
25201 CHAGRIN BLVD STE 390, BEACHWOOD, OH 44122-5637
(216) 770-3130
(216) 770-3100
Mailing address
1414 S GREEN RD STE 107, SOUTH EUCLID, OH 44121-3936
(440) 627-2600
(440) 627-2600
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366431850
—
OH
Enumeration date
01/27/2022
Last updated
01/27/2022
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