Provider Demographics
NPI:1376198465
Name:NEW LIFE HOME PLUS, LLC
Entity Type:Organization
Organization Name:NEW LIFE HOME PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARNOT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUNGUYA
Authorized Official - Suffix:
Authorized Official - Credentials:OPERATOR
Authorized Official - Phone:316-617-1788
Mailing Address - Street 1:PO BOX 782431
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67278-2431
Mailing Address - Country:US
Mailing Address - Phone:316-867-2306
Mailing Address - Fax:316-358-7667
Practice Address - Street 1:1214 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2657
Practice Address - Country:US
Practice Address - Phone:316-867-2306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care