MEDICARE: NEW LIFE FOUNDATIONS

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		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770716235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE FOUNDATIONS

Provider Business Mailing Address
First Line	:	614 NORTH MADISION BLVD
Second Line	:
City	:	ROXBORO
State	:	NC
Zip	:	27573-4636
Country	:	US
Telephone Number	:	919-672-0751
Fax Number	:

Provider Business Practice Location Address
First Line	:	5021 MILLER DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-1877
Country	:	US
Telephone Number	:	919-672-0751
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS LESLIE L BREWSTER
Credential	:	C.M./QP
Telephone Number	:	919-672-0751

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	09/01/2009

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Directions to “NEW LIFE FOUNDATIONS ” Practice Location

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