Provider Demographics
NPI:1689203820
Name:NEW LIFE DIRECT CARE STAFFING LLC
Entity Type:Organization
Organization Name:NEW LIFE DIRECT CARE STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SUPPORT SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:313-244-1863
Mailing Address - Street 1:20007 MCCORMICK ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1147
Mailing Address - Country:US
Mailing Address - Phone:313-244-1863
Mailing Address - Fax:313-473-8218
Practice Address - Street 1:20007 MCCORMICK ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1147
Practice Address - Country:US
Practice Address - Phone:313-244-1863
Practice Address - Fax:313-473-8218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care