Healthcare Provider Details

I. General information

NPI: 1376198465
Provider Name (Legal Business Name): NEW LIFE HOME PLUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 N CHARLOTTE ST
WICHITA KS
67208-2657
US

IV. Provider business mailing address

PO BOX 782431
WICHITA KS
67278-2431
US

V. Phone/Fax

Practice location:
  • Phone: 316-867-2306
  • Fax:
Mailing address:
  • Phone: 316-867-2306
  • Fax: 316-358-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ARNOT W MUNGUYA
Title or Position: ADMINISTRATOR
Credential: OPERATOR
Phone: 316-617-1788