Provider Demographics
NPI:1053334284
Name:NEW LIFE CARE SERVICES, LLC.
Entity Type:Organization
Organization Name:NEW LIFE CARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN-CLIFFORD
Authorized Official - Middle Name:AGBASI
Authorized Official - Last Name:OBIH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:504-885-8767
Mailing Address - Street 1:5416 VETERANS MEMORIAL BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-1747
Mailing Address - Country:US
Mailing Address - Phone:504-885-8767
Mailing Address - Fax:504-885-9757
Practice Address - Street 1:5416 VETERANS MEMORIAL BLVD STE 303
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-1747
Practice Address - Country:US
Practice Address - Phone:504-885-8767
Practice Address - Fax:504-885-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASIL 12125251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1363081Medicaid