Provider Demographics
NPI:1912787318
Name:NEW LIFE SUPERIOR CARE LLC
Entity Type:Organization
Organization Name:NEW LIFE SUPERIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-962-4353
Mailing Address - Street 1:521 CATHEDRAL DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-1925
Mailing Address - Country:US
Mailing Address - Phone:470-962-4353
Mailing Address - Fax:
Practice Address - Street 1:521 CATHEDRAL DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-1925
Practice Address - Country:US
Practice Address - Phone:470-962-4353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care