Healthcare Provider Details

I. General information

NPI: 1821315078
Provider Name (Legal Business Name): NEW LIFE HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 E STATE ST
TRENTON NJ
08609-1411
US

IV. Provider business mailing address

827 E STATE ST
TRENTON NJ
08609-1411
US

V. Phone/Fax

Practice location:
  • Phone: 609-458-9969
  • Fax: 609-218-2422
Mailing address:
  • Phone: 609-458-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberHP0141100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberHP0141100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberHP0141100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHP0141100
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SETH Z. TAYLOR SR.
Title or Position: PRESIDENT
Credential: BTH
Phone: 609-223-7635