Provider Demographics
NPI:1245303049
Name:NEW LIFE COMMUNITY ADULT DAYCARE INC.
Entity type:Organization
Organization Name:NEW LIFE COMMUNITY ADULT DAYCARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STATORY AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-522-3900
Mailing Address - Street 1:PO BOX 5183
Mailing Address - Street 2:166 PARK AVE W. SUITE 207
Mailing Address - City:MANSFIELD,
Mailing Address - State:OH
Mailing Address - Zip Code:44901
Mailing Address - Country:US
Mailing Address - Phone:419-522-3900
Mailing Address - Fax:419-522-8300
Practice Address - Street 1:166 PARK AVE W
Practice Address - Street 2:166 PARK AVE W. SUITE 207
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1637
Practice Address - Country:US
Practice Address - Phone:419-522-3900
Practice Address - Fax:419-522-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health