Active NPI
New Life Treatment Center
- Physician Assistant
- Woodstock, MN
National Provider Identifier
1417492810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Legal business name
- NEW LIFE TREATMENT CENTER
- Practice address
- 130 Dakota St
Woodstock, MN 56186 - Phone
- (507) 777-4321
- Fax
- (507) 777-4284
- NPI assigned
- Dec 21, 2016
- Last updated
- Dec 21, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Cheryl Thacker
- Title
- Executive Director
- Phone
- (507) 777-4321
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NU | Primary | |
| Family Nurse Practitioner | 363LF0000X | NU | ||
| Psychologist | 103T00000X | NU |
Addresses
Primary practice location
130 Dakota St
Woodstock, MN 56186
Mailing address
130 Dakota St S
Woodstock, MN 56186-1037
Phone (507) 777-4321
National Provider Directory
National Provider Directory- Tax ID family
- New Life Treatment Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Substance Abuse Rehabilitation Facility
- Woodstock, MN
- NPI 1043219728
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Psychologist
- Woodstock, MN
- NPI 1528145083
-
- Clinical Social Worker
- Woodstock, MN
- NPI 1306657135
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482278400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1482278400000",
"number": "1417492810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 DAKOTA ST S",
"city": "WOODSTOCK",
"state": "MN",
"postal_code": "561861037",
"telephone_number": "507-777-4321",
"fax_number": "507-777-4284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 DAKOTA ST",
"city": "WOODSTOCK",
"state": "MN",
"postal_code": "56186",
"telephone_number": "507-777-4321",
"fax_number": "507-777-4284"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NEW LIFE TREATMENT CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2016-12-21",
"last_updated": "2016-12-21",
"status": "A",
"authorized_official_last_name": "THACKER",
"authorized_official_first_name": "CHERYL",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "507-777-4321"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.