Provider Demographics
NPI:1033639489
Name:NEW SOUTH DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:NEW SOUTH DEVELOPMENT CORPORATION
Other - Org Name:GLOBAL CANNABIS COLLECTIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-305-9894
Mailing Address - Street 1:7301 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-2031
Mailing Address - Country:US
Mailing Address - Phone:1800-305-9894
Mailing Address - Fax:
Practice Address - Street 1:7301 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-2031
Practice Address - Country:US
Practice Address - Phone:180-030-5989
Practice Address - Fax:800-305-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251G00000X, 251S00000X, 253Z00000X, 261QM1300X, 332900000X, 343900000X
CA3752661251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992176192Medicaid