Provider Demographics
NPI:1992023279
Name:NEW LIFE PERSONAL CARE LLC
Entity Type:Organization
Organization Name:NEW LIFE PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEVELLE
Authorized Official - Middle Name:LIESA
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-721-1647
Mailing Address - Street 1:234 LITTLE JOHN DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-6124
Mailing Address - Country:US
Mailing Address - Phone:225-272-2234
Mailing Address - Fax:
Practice Address - Street 1:234 LITTLE JOHN DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-6124
Practice Address - Country:US
Practice Address - Phone:225-272-2234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15280253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1803430Medicaid