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General NPI Number Information
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NPI Number | 1467212415
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Entity Type | Organization
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Legal Business Name | NEW LIFE ASSISTED LIVING FACILITY, LLC
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 562 W 5TH ST
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-7402
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Country | US
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Telephone | 561-247-6220
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Fax | 561-401-0249
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Provider Business Mailing Address
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Address Line | 562 W 5TH ST
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-7402
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Country | US
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Telephone | 561-247-6220
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Fax | 561-401-0249
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LATONYA ROYAL
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Credential |
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Telephone | 561-502-4211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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