Healthcare Provider Details

I. General information

NPI: 1710357595
Provider Name (Legal Business Name): NEW LIFE COUNSELING AND COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19421 TIREMAN ST
DETROIT MI
48228-3337
US

IV. Provider business mailing address

19421 TIREMAN AVE
DETROIT MI
48228
US

V. Phone/Fax

Practice location:
  • Phone: 313-204-5931
  • Fax:
Mailing address:
  • Phone: 313-465-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number6301015504
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number6301015504
License Number StateMI

VIII. Authorized Official

Name: PATRICK EYO
Title or Position: CEO
Credential:
Phone: 313-465-5111