Provider Demographics
NPI:1396833679
Name:NEW LIFE REHAB SERVICES INC
Entity Type:Organization
Organization Name:NEW LIFE REHAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-672-9303
Mailing Address - Street 1:790 CARDINAL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5202
Mailing Address - Country:US
Mailing Address - Phone:252-672-9303
Mailing Address - Fax:252-672-9302
Practice Address - Street 1:790 CARDINAL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5202
Practice Address - Country:US
Practice Address - Phone:252-672-9303
Practice Address - Fax:252-672-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013 POOtherBCBS NC PROVIDER #
NC7200096Medicaid
NC7200096Medicaid