Provider Demographics
NPI:1710357595
Name:NEW LIFE COUNSELING AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:NEW LIFE COUNSELING AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:EYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-465-5111
Mailing Address - Street 1:19421 TIREMAN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228
Mailing Address - Country:US
Mailing Address - Phone:313-465-5111
Mailing Address - Fax:
Practice Address - Street 1:19421 TIREMAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3337
Practice Address - Country:US
Practice Address - Phone:313-204-5931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015504251C00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care