Healthcare Provider Details

I. General information

NPI: 1386653814
Provider Name (Legal Business Name): NEW LIFE OF COMMUNITY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6722 BUSTLETON AVE
PHILADELPHIA PA
19149-2301
US

IV. Provider business mailing address

6722 BUSTLETON AVE
PHILADELPHIA PA
19149-2301
US

V. Phone/Fax

Practice location:
  • Phone: 215-708-2100
  • Fax: 215-708-1650
Mailing address:
  • Phone: 215-708-2100
  • Fax: 215-708-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number100250
License Number StatePA

VIII. Authorized Official

Name: MR. GARY GAFT
Title or Position: VICE PRESIDENT/ADMINISTRATOR
Credential:
Phone: 215-708-2100