Provider Demographics
NPI:1255010500
Name:NEW OPPORTUNITIES AT LIFE 360 SERVICES, LLC
Entity type:Organization
Organization Name:NEW OPPORTUNITIES AT LIFE 360 SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JUNIUS
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, QMHP
Authorized Official - Phone:804-908-0942
Mailing Address - Street 1:12709 BEN FRY DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-4849
Mailing Address - Country:US
Mailing Address - Phone:804-908-0942
Mailing Address - Fax:
Practice Address - Street 1:12709 BEN FRY DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-4849
Practice Address - Country:US
Practice Address - Phone:804-908-0942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health