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General NPI Number Information
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NPI Number | 1215181953
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Entity Type | Organization
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Legal Business Name | NEW LIFE FAMILY SERVICE
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 112 CORLISS ST
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City | GREENSBORO
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State | NC
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Zip | 27406-5208
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Country | US
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Telephone | 336-235-1969
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Fax |
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Provider Business Mailing Address
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Address Line | 112 CORLISS ST
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City | GREENSBORO
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State | NC
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Zip | 27406-5208
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Country | US
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Telephone | 336-235-1969
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRIA LEE PARKS
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Credential |
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Telephone | 336-235-1969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-041-644
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License Number State | NC
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