Provider Demographics
NPI:1366777286
Name:NEW LIFE SERVICES, INC
Entity type:Organization
Organization Name:NEW LIFE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-671-4067
Mailing Address - Street 1:2003 GODWIN AVE
Mailing Address - Street 2:C
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3197
Mailing Address - Country:US
Mailing Address - Phone:910-671-4067
Mailing Address - Fax:910-671-0383
Practice Address - Street 1:2003 GODWIN AVE STE C
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-671-4067
Practice Address - Fax:910-671-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-179251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1700962776Medicaid
NC1801924246Medicaid