MEDICARE: NEW LIFE MENTAL SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1225702764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE MENTAL SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	3750 W 16TH AVE STE 126U
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4645
Country	:	US
Telephone Number	:	786-222-5980
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 W 16TH AVE STE 126U
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4645
Country	:	US
Telephone Number	:	786-222-5980
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NOELIA REYES ALONSO
Credential	:
Telephone Number	:	786-222-5980

Provider Enumeration Date	:	08/08/2021
Last Update Date	:	08/08/2021

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