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LIFE REDISCOVERY CENTER LLC NPI 1427416577


NPI Information

NPI: 1427416577
Provider Name: LIFE REDISCOVERY CENTER, LLC
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization

CLIA Number: 11D2131834

Address:
113 UPPER RIVERDALE RD SW
RIVERDALE, GA
ZIP 30274
Phone: (678) 545-6768
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LIFE REDISCOVERY CENTER, LLC is a community behavioral health in Riverdale, GA. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. LIFE REDISCOVERY CENTER, LLC NPI is 1427416577. The provider is registered as an organization entity type.

The provider's business location address is:

113 UPPER RIVERDALE RD SW
RIVERDALE, GA
ZIP 30274-540
Phone: (678) 545-6768
Fax: (678) 528-9489

The provider's authorized official is Felicia Watts .
The authorized official title is Ceo and has the following contact phone number (678) 545-6768.

The CLIA number assigned to this NPI record is 11D2131834 - other - core provider with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/3/2016 and was last updated on 4/19/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No
2251S00000XCommunity/Behavioral HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1003212493AMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.