Provider Demographics
NPI:1083047161
Name:NEW LIFE FOR WOMEN, INC.
Entity Type:Organization
Organization Name:NEW LIFE FOR WOMEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-355-2195
Mailing Address - Street 1:814 N CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2551
Mailing Address - Country:US
Mailing Address - Phone:601-355-2195
Mailing Address - Fax:601-354-4193
Practice Address - Street 1:814 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2551
Practice Address - Country:US
Practice Address - Phone:601-355-2195
Practice Address - Fax:601-354-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)