Healthcare Provider Details

I. General information

NPI: 1346987237
Provider Name (Legal Business Name): NEW LIFE FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 DEBORAH ST
INDIANAPOLIS IN
46222-4635
US

IV. Provider business mailing address

12683 LARGO DR
FISHERS IN
46037-8189
US

V. Phone/Fax

Practice location:
  • Phone: 317-366-8249
  • Fax:
Mailing address:
  • Phone: 317-366-8249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: LASHANDA MONTGOMERY
Title or Position: OWNER
Credential: BS
Phone: 317-366-8249