Provider Demographics
NPI:1780099333
Name:NEW LIFE COUNSELING AND COMMUNITY SERVICES, LLC
Entity type:Organization
Organization Name:NEW LIFE COUNSELING AND COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JUMBO
Authorized Official - Last Name:EYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-465-5111
Mailing Address - Street 1:7810 SOUTHFIELD FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3580
Mailing Address - Country:US
Mailing Address - Phone:313-465-5111
Mailing Address - Fax:
Practice Address - Street 1:7810 SOUTHFIELD FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3580
Practice Address - Country:US
Practice Address - Phone:313-465-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015504385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child