Healthcare Provider Details

I. General information

NPI: 1396490124
Provider Name (Legal Business Name): NEW LIFE CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 SIX FORKS RD STE 487
RALEIGH NC
27615-5276
US

IV. Provider business mailing address

PO BOX 24982
RALEIGH NC
27611-4982
US

V. Phone/Fax

Practice location:
  • Phone: 919-984-3849
  • Fax:
Mailing address:
  • Phone: 919-578-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANITA BENNETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-578-3849