Provider Demographics
NPI:1356685788
Name:NUELIFE HEALTH SYSTEM, LLC
Entity Type:Organization
Organization Name:NUELIFE HEALTH SYSTEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BUS. MGR.
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-479-9856
Mailing Address - Street 1:4173 HEARTHSIDE DR
Mailing Address - Street 2:104
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-8539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 N 13TH ST
Practice Address - Street 2:19 C
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-1700
Practice Address - Country:US
Practice Address - Phone:910-230-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2965251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC2965OtherSTATE OF NC