Provider Demographics
NPI:1780232876
Name:NEW LIFE WELLNESS COMMUNITY LLC
Entity Type:Organization
Organization Name:NEW LIFE WELLNESS COMMUNITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YULAIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-239-4074
Mailing Address - Street 1:6295 LAKE WORTH RD STE 19
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3033
Mailing Address - Country:US
Mailing Address - Phone:786-930-0548
Mailing Address - Fax:
Practice Address - Street 1:6295 LAKE WORTH RD # 28-29
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2909
Practice Address - Country:US
Practice Address - Phone:786-351-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-31
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108821800Medicaid
FL104190700Medicaid