Healthcare Provider Details

I. General information

NPI: 1245489400
Provider Name (Legal Business Name): NEW LIFE COMMUNITY SERVICE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6932 9TH ST NW
WASHINGTON DC
20012-2406
US

IV. Provider business mailing address

PO BOX 5592
HYATTSVILLE MD
20782-0592
US

V. Phone/Fax

Practice location:
  • Phone: 202-390-2106
  • Fax: 202-269-4503
Mailing address:
  • Phone: 202-390-2106
  • Fax: 202-269-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. RENEE MARQURITA BELFON
Title or Position: DIRECTOR
Credential:
Phone: 202-390-2697