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General NPI Number Information
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NPI Number | 1093185233
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Entity Type | Organization
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Legal Business Name | NEW LIFE HEALTH CARE AGENCY LLC
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 3642 NOTTINGHAM WAY
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City | HAMILTON
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State | NJ
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Zip | 08690-2612
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Country | US
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Telephone | 609-890-2804
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Fax | 609-890-2803
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Provider Business Mailing Address
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Address Line | 3642 NOTTINGHAM WAY
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City | HAMILTON
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State | NJ
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Zip | 08690-2612
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Country | US
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Telephone | 609-890-2804
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Fax | 609-890-2803
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. SETH Z. TAYLOR SR.
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Credential | BSC
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Telephone | 609-890-2804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | HP011100
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License Number State | NJ
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