Provider Demographics
NPI:1437164811
Name:NEW LIFE CENTER FOR FAMILY DEVELOPMENT
Entity Type:Organization
Organization Name:NEW LIFE CENTER FOR FAMILY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-323-3665
Mailing Address - Street 1:8338 COMANCHE NE
Mailing Address - Street 2:B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-323-3665
Mailing Address - Fax:505-323-1038
Practice Address - Street 1:8338 COMANCHE RD NE
Practice Address - Street 2:B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2304
Practice Address - Country:US
Practice Address - Phone:505-323-3665
Practice Address - Fax:505-323-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34083260Medicaid
NM76804OtherPRESBYTERIAN HEALTH PLAN
NM10006701OtherLOVELACE HEALTH PLAN
NMNM00JB93OtherBLUE CROSS BLUE SHIELD NM