Provider Demographics
NPI:1538515564
Name:NEW VITAE INC
Entity Type:Organization
Organization Name:NEW VITAE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROJECT MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTH
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:610-965-9021
Mailing Address - Street 1:P.O. BOX 1001
Mailing Address - Street 2:5201 ST JOSEPHS ROAD
Mailing Address - City:LIMEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18060-0010
Mailing Address - Country:US
Mailing Address - Phone:610-965-9021
Mailing Address - Fax:610-928-0174
Practice Address - Street 1:27 S 55TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139
Practice Address - Country:US
Practice Address - Phone:267-499-4299
Practice Address - Fax:267-713-7372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA144110251K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007458450Medicaid
PA1007458450Medicaid