Provider Demographics
NPI:1023441987
Name:NEW LIFE CARE CENTER INT
Entity type:Organization
Organization Name:NEW LIFE CARE CENTER INT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-696-9886
Mailing Address - Street 1:650 S COUNTRY CLUB DR APT 125
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2341
Mailing Address - Country:US
Mailing Address - Phone:480-696-9886
Mailing Address - Fax:
Practice Address - Street 1:650 S COUNTRY CLUB DR APT 125
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2341
Practice Address - Country:US
Practice Address - Phone:480-696-9886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ394330302F00000X
AZ21024385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No302F00000XManaged Care OrganizationsExclusive Provider Organization