Provider Demographics
NPI:1316554215
Name:A NEW WAY OF LIFE MENTORING SERVICES
Entity Type:Organization
Organization Name:A NEW WAY OF LIFE MENTORING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:TENE
Authorized Official - Last Name:CHENEY-GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-695-8329
Mailing Address - Street 1:7601 FM 1960 RD E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2209
Mailing Address - Country:US
Mailing Address - Phone:770-695-8329
Mailing Address - Fax:
Practice Address - Street 1:7601 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2209
Practice Address - Country:US
Practice Address - Phone:770-695-8329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management