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General NPI Number Information
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NPI Number | 1679697270
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Entity Type | Organization
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Legal Business Name | NEW LIFE COMMUNITY SUPPORTS, INC.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 117 N RAILROAD STREET
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City | AHOSKIE
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State | NC
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Zip | 27910
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Country | US
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Telephone | 252-332-2816
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Fax | 252-332-4189
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Provider Business Mailing Address
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Address Line | 117 N RAILROAD STREET PO BOX 148
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City | AHOSKIE
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State | NC
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Zip | 27910
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Country | US
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Telephone | 252-332-2816
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Fax | 252-332-4189
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Authorized Official
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Title or Position | QP-CEO
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Name | MRS. AVA MOORE-DANIELS
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Credential |
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Telephone | 252-332-2816
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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 | NC
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