MEDICARE: NEW LIFE ASSISTED LIVING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	8982	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295038032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE ASSISTED LIVING, INC.

Provider Business Mailing Address
First Line	:	2133 SHELTER DRIVE
Second Line	:
City	:	PORT ST. LUCIE
State	:	FL
Zip	:	34952
Country	:	US
Telephone Number	:	772-337-0058
Fax Number	:	772-398-4238

Provider Business Practice Location Address
First Line	:	2133 SHELTER DRIVE
Second Line	:
City	:	PORT ST. LUCIE
State	:	FL
Zip	:	34952
Country	:	US
Telephone Number	:	772-337-0058
Fax Number	:	772-398-4238

Authorized Official
Title or Position	:	OWNER
Name	:	ETHEL NEWTON
Credential	:
Telephone Number	:	772-337-0058

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	12/22/2010

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