Provider Demographics
NPI:1558544593
Name:NEW LIFE HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:NEW LIFE HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TEARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-407-0195
Mailing Address - Street 1:1001 W EVANS ST SUITE 202
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3388
Mailing Address - Country:US
Mailing Address - Phone:843-407-0196
Mailing Address - Fax:843-536-0480
Practice Address - Street 1:1001 W EVANS ST SUITE 202
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3388
Practice Address - Country:US
Practice Address - Phone:843-407-0196
Practice Address - Fax:843-536-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health