Organization
NEW LIFE MEDCO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELWOOD P NYTHER LCSW (COO)
(773) 818-9607
Entity
Organization
Contact information
Practice address
329 W 18TH ST, STE 500, CHICAGO, IL 60619
(773) 818-9607
Mailing address
329 W 18TH, STE 500 BOX 20, CHICAGO, IL 60616
(773) 818-9607
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
149004694
IL
Other
Enumeration date
03/22/2010
Last updated
03/22/2010
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