Organization
LIFESTYLE RECOVERY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW JAMES REILLY LADAC NM #3652 (DIRECTOR/OWNER)
(505) 345-6801
Entity
Organization
Contact information
Practice address
3911 4TH ST NW STE B, ALBUQUERQUE, NM 87107-2510
(505) 345-6801
Mailing address
3911 4TH ST NW STE B, ALBUQUERQUE, NM 87107-2510
(505) 345-6801
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
02-491408-00-8
NM
Other
Enumeration date
05/12/2008
Last updated
05/12/2008
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