Healthcare Provider Details

I. General information

NPI: 1396250056
Provider Name (Legal Business Name): NEW LIFE COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 FAIR AVE
SANTA CRUZ CA
95060
US

IV. Provider business mailing address

707 FAIR AVE
SANTA CRUZ CA
95060
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-1007
  • Fax: 831-454-0545
Mailing address:
  • Phone: 831-427-1007
  • Fax: 831-454-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number440010AN
License Number StateCA

VIII. Authorized Official

Name: STACEY PALAU
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 831-298-5482