Healthcare Provider Details

I. General information

NPI: 1679809222
Provider Name (Legal Business Name): NEW LIFE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 GREEN ST SUITE 205
FAYETTEVILLE NC
28301-5061
US

IV. Provider business mailing address

109 GREEN ST SUITE 205
FAYETTEVILLE NC
28301-5061
US

V. Phone/Fax

Practice location:
  • Phone: 910-223-5347
  • Fax: 910-223-5348
Mailing address:
  • Phone: 910-223-5347
  • Fax: 910-223-5348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TEARA JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 910-237-5042