Provider Demographics
NPI:1952570806
Name:NEW CREATION HEALTH CARE LLC
Entity Type:Organization
Organization Name:NEW CREATION HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALISA
Authorized Official - Middle Name:SHAVONN
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:705-421-5871
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-0563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:821 12TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2749
Practice Address - Country:US
Practice Address - Phone:706-421-5871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN04788251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health