Provider Demographics
NPI:1396490124
Name:NEW LIFE CONNECTION
Entity type:Organization
Organization Name:NEW LIFE CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-578-3849
Mailing Address - Street 1:PO BOX 24982
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27611-4982
Mailing Address - Country:US
Mailing Address - Phone:919-578-3849
Mailing Address - Fax:
Practice Address - Street 1:8601 SIX FORKS RD STE 487
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5276
Practice Address - Country:US
Practice Address - Phone:919-984-3849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No347C00000XTransportation ServicesPrivate Vehicle