Provider Demographics
NPI:1033759659
Name:NEW LIFE ALTERNATIVES LLC
Entity Type:Organization
Organization Name:NEW LIFE ALTERNATIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEVERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADOLPHUS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:313-915-9138
Mailing Address - Street 1:24340 DANTE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3610
Mailing Address - Country:US
Mailing Address - Phone:313-915-9138
Mailing Address - Fax:
Practice Address - Street 1:31235 HARPER AVE STE 244
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1425
Practice Address - Country:US
Practice Address - Phone:313-915-9138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-11
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty