Provider Demographics
NPI:1407310956
Name:NEW LIFE CARE SERVICE LLC
Entity Type:Organization
Organization Name:NEW LIFE CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PORTERESHICE
Authorized Official - Middle Name:SHUNTA
Authorized Official - Last Name:BRABHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-686-0632
Mailing Address - Street 1:411 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:SC
Mailing Address - Zip Code:29810-3717
Mailing Address - Country:US
Mailing Address - Phone:803-686-0632
Mailing Address - Fax:
Practice Address - Street 1:411 MAIN ST N
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:SC
Practice Address - Zip Code:29810-3717
Practice Address - Country:US
Practice Address - Phone:803-686-0632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health