Provider Demographics
NPI:1508096454
Name:NEW LIFE ADULT CARE II, INC
Entity Type:Organization
Organization Name:NEW LIFE ADULT CARE II, INC
Other - Org Name:NEW LIFE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEABROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-661-9453
Mailing Address - Street 1:710 OAKFIELD DR STE 116
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4931
Mailing Address - Country:US
Mailing Address - Phone:813-661-9453
Mailing Address - Fax:813-654-9897
Practice Address - Street 1:710 OAKFIELD DR STE 116
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4931
Practice Address - Country:US
Practice Address - Phone:813-661-9453
Practice Address - Fax:813-661-0155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LIFE ADULT CARE II, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-24
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211307251E00000X
FLAL11996310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685573301Medicaid
FL684811701Medicaid