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General NPI Number Information
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NPI Number | 1245303049
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Entity Type | Organization
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Legal Business Name | NEW LIFE COMMUNITY ADULT DAYCARE INC.
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 166 PARK AVE W 166 PARK AVE W. SUITE 207
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City | MANSFIELD
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State | OH
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Zip | 44902-1637
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Country | US
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Telephone | 419-522-3900
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Fax | 419-522-8300
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Provider Business Mailing Address
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Address Line | PO BOX 5183 166 PARK AVE W. SUITE 207
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City | MANSFIELD
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State | OH
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Zip | 44901
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Country | US
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Telephone | 419-522-3900
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Fax | 419-522-8300
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Authorized Official
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Title or Position | STATORY AGENT
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Name | MRS. LENORE MELTON
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Credential |
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Telephone | 419-522-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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