Healthcare Provider Details

I. General information

NPI: 1962425199
Provider Name (Legal Business Name): NEW LIFE CARE SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5416 VETERANS MEMORIAL BLVD STE 303
METAIRIE LA
70003-1747
US

IV. Provider business mailing address

5416 VETERANS MEMORIAL BLVD STE 303
METAIRIE LA
70003-1747
US

V. Phone/Fax

Practice location:
  • Phone: 504-885-8767
  • Fax: 504-885-9757
Mailing address:
  • Phone: 504-885-8767
  • Fax: 504-885-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberPCA 12124
License Number StateLA

VIII. Authorized Official

Name: DR. JOHN-CLIFFORD AGBASI OBIH
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 504-885-8767