Organization
NEW LIFE OUTPATIENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUSTIN GROSS IADC (CLINICAL MANAGER)
(563) 355-0055
Entity
Organization
Contact information
Practice address
2322 E KIMBERLY RD, STE. 200 NORTH, DAVENPORT, IA 52807-7205
(563) 355-0055
(563) 355-0101
Mailing address
2322 E KIMBERLY RD, STE. 200 NORTH, DAVENPORT, IA 52807-7205
(563) 355-0055
(563) 355-0101
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
101YA0400X
IA
Other
Enumeration date
10/20/2015
Last updated
10/20/2015
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