Provider Demographics
NPI:1801060900
Name:NEW LIFE COMMUNITY SERVICE, LLC
Entity type:Organization
Organization Name:NEW LIFE COMMUNITY SERVICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RESIDENT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELFON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-269-1140
Mailing Address - Street 1:P.O. BOX 5592
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782
Mailing Address - Country:US
Mailing Address - Phone:202-390-2106
Mailing Address - Fax:202-832-0209
Practice Address - Street 1:1403 HAMLLIN STREET, N.E.
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-269-1140
Practice Address - Fax:202-269-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCALR-0025305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization