Provider Demographics
NPI:1386653814
Name:NEW LIFE OF COMMUNITY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:NEW LIFE OF COMMUNITY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-708-2100
Mailing Address - Street 1:6722 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2301
Mailing Address - Country:US
Mailing Address - Phone:215-708-2100
Mailing Address - Fax:215-708-1650
Practice Address - Street 1:6722 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2301
Practice Address - Country:US
Practice Address - Phone:215-708-2100
Practice Address - Fax:215-708-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100250261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016619250001Medicaid
PA0016619250001Medicaid