Provider Demographics
NPI:1679514079
Name:NEW LIFE CENTER COMMISSION ON ALCOHOL & OTHER DRUG ABUSE
Entity Type:Organization
Organization Name:NEW LIFE CENTER COMMISSION ON ALCOHOL & OTHER DRUG ABUSE
Other - Org Name:DAODAS NEW LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NCAC II, AADC, SAP
Authorized Official - Phone:803-943-2800
Mailing Address - Street 1:102 GINN ALTMAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-3932
Mailing Address - Country:US
Mailing Address - Phone:803-943-2800
Mailing Address - Fax:803-943-2267
Practice Address - Street 1:102 GINN ALTMAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-3932
Practice Address - Country:US
Practice Address - Phone:803-943-2800
Practice Address - Fax:803-943-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD17LCMedicaid