Provider Demographics
NPI:1659794766
Name:NEW FOUND LIFE OF DELRAY BEACH
Entity Type:Organization
Organization Name:NEW FOUND LIFE OF DELRAY BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:IACULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-270-2361
Mailing Address - Street 1:210 NE 6TH AVE
Mailing Address - Street 2:103-104
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:223 NE 5TH AVE
Practice Address - Street 2:SUITE 103-104
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5530
Practice Address - Country:US
Practice Address - Phone:561-270-2361
Practice Address - Fax:561-270-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800027026291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL800027026OtherAGENCY FOR HEALTH CARE ADMINISTRATION
FL10D2035690OtherCLIA