NEW LIFE WELLNESS LLC NPI 1508463639

NPI Information

NPI: 1508463639
Provider Name: NEW LIFE WELLNESS LLC
Classification: Preventive Medicine - 2083A0300X
Specialization: Addiction Medicine
Entity Type: Organization
CLIA Number: 38D2309350
Address: 256 E HURLBURT AVE STE 117
HERMISTON, OR
ZIP 97838
Phone: (541) 303-3558

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NPI Details

NEW LIFE WELLNESS LLC is an addiction medicine preventive medicine in Hermiston, OR. The provider is a physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction. NEW LIFE WELLNESS LLC NPI is 1508463639. The provider is registered as an organization entity type.

The provider's business location address is:

256 E HURLBURT AVE STE 117
HERMISTON, OR
ZIP 97838-443
Phone: (541) 303-3558
Fax: (509) 593-4644

The provider's authorized official is Randall Kelly .
The authorized official title is Physician Assistant, Owner and has the following contact phone number (206) 418-8222.

The CLIA number assigned to this NPI record is 38D2309350 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/1/2020 and was last updated on 11/14/2025.

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	Primary
1	261QM2500X	Clinic/Center	Medical Specialty	No
2	261QM0850X	Clinic/Center	Adult Mental Health	No
3	101YA0400X	Counselor	Addiction (Substance Use Disorder)	No
4	2083A0300X	Preventive Medicine	Addiction Medicine	Yes

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
1	500698482	MEDICAID	OREGON

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: 11/21/2025

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