Provider Demographics
NPI:1245412246
Name:NEW VISIONS OF LIFE CARE SERV. LLC
Entity Type:Organization
Organization Name:NEW VISIONS OF LIFE CARE SERV. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:BEN
Authorized Official - Suffix:
Authorized Official - Credentials:BSM, BUSINESS MANAGE
Authorized Official - Phone:504-367-7724
Mailing Address - Street 1:3848 SUE KER DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058
Mailing Address - Country:US
Mailing Address - Phone:504-367-7724
Mailing Address - Fax:504-367-7725
Practice Address - Street 1:1901 WESTBANK EXPRESSWAY
Practice Address - Street 2:STE. 400
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-367-7724
Practice Address - Fax:504-367-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7151251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1023663Medicaid
LA7151OtherPCA PROGRAM