MEDICARE: NEW LIFE COMMUNITY ADULT DAYCARE INC.

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1245303049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE COMMUNITY ADULT DAYCARE INC.

Provider Business Mailing Address
First Line	:	PO BOX 5183
Second Line	:	166 PARK AVE W. SUITE 207
City	:	MANSFIELD
State	:	OH
Zip	:	44901
Country	:	US
Telephone Number	:	419-522-3900
Fax Number	:	419-522-8300

Provider Business Practice Location Address
First Line	:	166 PARK AVE W
Second Line	:	166 PARK AVE W. SUITE 207
City	:	MANSFIELD
State	:	OH
Zip	:	44902-1637
Country	:	US
Telephone Number	:	419-522-3900
Fax Number	:	419-522-8300

Authorized Official
Title or Position	:	STATORY AGENT
Name	:	MRS. LENORE MELTON
Credential	:
Telephone Number	:	419-522-3900

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	08/22/2020

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