Provider Demographics
NPI:1508861097
Name:NEW LIFE HOME HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:NEW LIFE HOME HEALTH CARE AGENCY
Other - Org Name:NEW LIFE HOME CARE & HOSPICE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:APEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-947-8220
Mailing Address - Street 1:2655 PHILMONT AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-5314
Mailing Address - Country:US
Mailing Address - Phone:215-947-8220
Mailing Address - Fax:215-938-1211
Practice Address - Street 1:2655 PHILMONT AVE
Practice Address - Street 2:STE 101
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-5314
Practice Address - Country:US
Practice Address - Phone:215-947-8220
Practice Address - Fax:215-938-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02150501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02150501OtherAGENCY-STATE ID
PA1008846060001Medicaid
PA1008846060001Medicaid