Provider Demographics
NPI:1083356133
Name:NEW LIFE HOME LLC
Entity Type:Organization
Organization Name:NEW LIFE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-372-7821
Mailing Address - Street 1:1070 NE COUNTRY CLUB AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-6016
Mailing Address - Country:US
Mailing Address - Phone:503-491-9333
Mailing Address - Fax:
Practice Address - Street 1:1070 NE COUNTRY CLUB AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-6016
Practice Address - Country:US
Practice Address - Phone:503-491-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty