Provider Demographics
NPI:1679697270
Name:NEW LIFE COMMUNITY SUPPORTS, INC.
Entity type:Organization
Organization Name:NEW LIFE COMMUNITY SUPPORTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QP-CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE-DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-332-2816
Mailing Address - Street 1:117 N RAILROAD STREET
Mailing Address - Street 2:PO BOX 148
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910
Mailing Address - Country:US
Mailing Address - Phone:252-332-2816
Mailing Address - Fax:252-332-4189
Practice Address - Street 1:117 N RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910
Practice Address - Country:US
Practice Address - Phone:252-332-2816
Practice Address - Fax:252-332-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management