Provider Demographics
NPI:1093185233
Name:NEW LIFE HEALTH CARE AGENCY LLC
Entity Type:Organization
Organization Name:NEW LIFE HEALTH CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:Z
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:SR
Authorized Official - Credentials:BSC
Authorized Official - Phone:609-890-2804
Mailing Address - Street 1:3642 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-2612
Mailing Address - Country:US
Mailing Address - Phone:609-890-2804
Mailing Address - Fax:609-890-2803
Practice Address - Street 1:3642 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-2612
Practice Address - Country:US
Practice Address - Phone:609-890-2804
Practice Address - Fax:609-890-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP011100302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization