Healthcare Provider Details

I. General information

NPI: 1003227281
Provider Name (Legal Business Name): NEW WAYS TCM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MODEST ST
LAKELAND FL
33805-3123
US

IV. Provider business mailing address

310 MODEST ST
LAKELAND FL
33805-3123
US

V. Phone/Fax

Practice location:
  • Phone: 863-899-5836
  • Fax: 866-271-5349
Mailing address:
  • Phone: 863-899-5836
  • Fax: 866-271-5349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE KIRNES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 863-899-5836