Provider Demographics
NPI:1467800136
Name:NEW WAY ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:NEW WAY ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-708-4556
Mailing Address - Street 1:2109 W WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1150
Mailing Address - Country:US
Mailing Address - Phone:602-708-4556
Mailing Address - Fax:480-452-0207
Practice Address - Street 1:2109 W WESTERN DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1150
Practice Address - Country:US
Practice Address - Phone:602-708-4556
Practice Address - Fax:480-452-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ121944OtherAHCCS