NPI:
1154490985
Provider Name:
ROSECRANCE NEW LIFE OUTPATIENT CENTER
Doing Business As: NEW OUTPATIENT CENTER
Classification:
Clinic/Center - 261QR0405X
Entity Type:
Organization
Specialization: Rehabilitation, Substance Use Disorder
CLIA Number: 16D2067598
Address:
2322 E KIMBERLY RD STE 200 PAUL REVERE SQ
DAVENPORT, IA
ZIP 52807
Phone:
(563) 355-0055
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ROSECRANCE NEW LIFE OUTPATIENT CENTER is a rehabilitation and substance use disorder clinic center in Davenport, IA. ROSECRANCE NEW LIFE OUTPATIENT CENTER NPI is 1154490985. The provider is registered as an organization entity type.
The provider Is Doing Business As New Outpatient Center.
The provider's business location address is:
2322 E KIMBERLY RD STE 200 PAUL REVERE SQ
DAVENPORT, IA
ZIP 52807-042
Phone: (563) 355-0055
Fax: (563) 355-0101
The provider's authorized official is John Schuster .
The authorized official title is Senior Vice President/cfo and has the following contact phone number (815) 387-5642.
The CLIA number assigned to this NPI record is 16D2067598 - practitioner other with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 11/7/2006 and was last updated on 1/23/2020.