Provider Demographics
NPI:1568737930
Name:MY NEW LIFE FOUNDATION, INC
Entity Type:Organization
Organization Name:MY NEW LIFE FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEMARIA
Authorized Official - Middle Name:LASHUNG
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-437-2593
Mailing Address - Street 1:1582 WESTWOOD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2366
Mailing Address - Country:US
Mailing Address - Phone:404-437-2593
Mailing Address - Fax:404-228-7957
Practice Address - Street 1:1607 RALPH DAVID ABERNATHY BLVD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1237
Practice Address - Country:US
Practice Address - Phone:404-437-2593
Practice Address - Fax:404-228-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-17
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility