Provider Demographics
NPI:1598830721
Name:A NEW WAY OF LIFE, INC.
Entity Type:Organization
Organization Name:A NEW WAY OF LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-896-0082
Mailing Address - Street 1:8007 N POINT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3268
Mailing Address - Country:US
Mailing Address - Phone:336-896-0082
Mailing Address - Fax:336-896-0084
Practice Address - Street 1:8007 N POINT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3268
Practice Address - Country:US
Practice Address - Phone:336-896-0082
Practice Address - Fax:336-896-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34-14954251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management