Provider Demographics
NPI:1366689564
Name:NEWLIFE FAMILY CARE
Entity Type:Organization
Organization Name:NEWLIFE FAMILY CARE
Other - Org Name:NEWLIFE FAMILY CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:REYES
Authorized Official - Last Name:GOSTOMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:972-442-7774
Mailing Address - Street 1:1314 CANYON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-6684
Mailing Address - Country:US
Mailing Address - Phone:972-442-7774
Mailing Address - Fax:972-442-7774
Practice Address - Street 1:1314 CANYON CREEK RD
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-6684
Practice Address - Country:US
Practice Address - Phone:972-442-7774
Practice Address - Fax:972-442-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-10
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management