Provider Demographics
NPI:1275598039
Name:NEW LIFE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:NEW LIFE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-449-7996
Mailing Address - Street 1:17122 BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5992
Mailing Address - Country:US
Mailing Address - Phone:714-848-7191
Mailing Address - Fax:714-375-7563
Practice Address - Street 1:17122 BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5992
Practice Address - Country:US
Practice Address - Phone:714-848-7191
Practice Address - Fax:714-375-7563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA556577Medicare Oscar/Certification