Provider Demographics
NPI:1649470113
Name:NEW LIFE CENTERS
Entity type:Organization
Organization Name:NEW LIFE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:801-281-3353
Mailing Address - Street 1:1255 E 3900 S STE 300
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1389
Mailing Address - Country:US
Mailing Address - Phone:801-281-3353
Mailing Address - Fax:801-281-3373
Practice Address - Street 1:1255 E 3900 S STE 300
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1389
Practice Address - Country:US
Practice Address - Phone:801-281-3353
Practice Address - Fax:801-281-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTSHCF-78054284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ222079Medicare ID - Type UnspecifiedPROVIDER TYPE 78, GSA 5,3