Provider Demographics
NPI:1598992752
Name:NEW LIFE HEALTHCARE AGENCY, INC
Entity Type:Organization
Organization Name:NEW LIFE HEALTHCARE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIGGS
Authorized Official - Middle Name:MAXWELL
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:410-323-5433
Mailing Address - Street 1:5209 YORK RD
Mailing Address - Street 2:SUITE M-16, MAIL BOX B-16
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4225
Mailing Address - Country:US
Mailing Address - Phone:410-323-5433
Mailing Address - Fax:410-435-5433
Practice Address - Street 1:5209 YORK RD
Practice Address - Street 2:SUITE M-16, MAIL BOX B-16
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4225
Practice Address - Country:US
Practice Address - Phone:410-323-5433
Practice Address - Fax:410-435-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2768P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health