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General NPI Number Information
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NPI Number | 1588269310
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Entity Type | Organization
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Legal Business Name | NEW BREED CREATION LIFE CENTER, INC.
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 7035 PHILIPS HWY STE 11
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6071
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Country | US
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Telephone | 904-253-3429
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Fax |
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Provider Business Mailing Address
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Address Line | 7035 PHILIPS HWY STE 11
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6071
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Country | US
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Telephone | 904-253-3429
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Fax |
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Authorized Official
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Title or Position | BILLING & CREDENTIALING SPECIALIST
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Name | TIFFANY HART
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Credential |
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Telephone | 904-300-7494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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