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General NPI Number Information
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NPI Number | 1922433259
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Entity Type | Organization
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Legal Business Name | NEW LIFE ASSISTED LIVING
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 1301 WYOMING AVE
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City | FORT PIERCE
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State | FL
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Zip | 34982
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Country | US
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Telephone | 772-882-4293
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 WYOMING AVE
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City | FORT PIERCE
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State | FL
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Zip | 34982-3645
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Country | US
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Telephone | 772-882-4293
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ETHEL NEWTON
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Credential |
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Telephone | 772-626-6161
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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 | 11797
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License Number State | FL
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