Provider Demographics
NPI:1679877724
Name:NEW LIFE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:NEW LIFE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-215-1172
Mailing Address - Street 1:PO BOX 8611
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-5735
Mailing Address - Country:US
Mailing Address - Phone:252-215-1172
Mailing Address - Fax:252-215-1173
Practice Address - Street 1:104 W FIRE TOWER RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9475
Practice Address - Country:US
Practice Address - Phone:252-215-1172
Practice Address - Fax:252-215-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center