Provider Demographics
NPI:1982023115
Name:NEW LIFE HEALTH AND MEDICAL
Entity Type:Organization
Organization Name:NEW LIFE HEALTH AND MEDICAL
Other - Org Name:NEW LIFE MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, PHD
Authorized Official - Phone:803-546-9553
Mailing Address - Street 1:701 GERVAIS ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3066
Mailing Address - Country:US
Mailing Address - Phone:803-546-9553
Mailing Address - Fax:
Practice Address - Street 1:701 MAIN ST.
Practice Address - Street 2:SUITE 150
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-546-9553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LIFE HEALTH AND MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 332B00000X, 3416A0800X
SC251S00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No3416A0800XTransportation ServicesAmbulanceAir Transport
No347C00000XTransportation ServicesPrivate Vehicle