Healthcare Provider Details

I. General information

NPI: 1508096454
Provider Name (Legal Business Name): NEW LIFE ADULT CARE II, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 OAKFIELD DR STE 116
BRANDON FL
33511-4931
US

IV. Provider business mailing address

710 OAKFIELD DR STE 116
BRANDON FL
33511-4931
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-9453
  • Fax: 813-661-0155
Mailing address:
  • Phone: 813-661-9453
  • Fax: 813-654-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number30211307
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11996
License Number StateFL

VIII. Authorized Official

Name: MRS. ROSALINE SEABROOK
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-661-9453