Provider Demographics
NPI:1689851081
Name:NEW LIFE THERAPUTIC CARE
Entity Type:Organization
Organization Name:NEW LIFE THERAPUTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-999-3516
Mailing Address - Street 1:8700 NAPIER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-9290
Mailing Address - Country:US
Mailing Address - Phone:313-999-3516
Mailing Address - Fax:313-561-0468
Practice Address - Street 1:8292 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659-8682
Practice Address - Country:US
Practice Address - Phone:248-349-5299
Practice Address - Fax:313-561-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI050015324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility