Provider Demographics
NPI:1689496911
Name:NEW LIFE 360 TEMPLE TERRACE INC
Entity type:Organization
Organization Name:NEW LIFE 360 TEMPLE TERRACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEEK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-418-1966
Mailing Address - Street 1:710 VANDERBAKER RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-7867
Mailing Address - Country:US
Mailing Address - Phone:813-418-1966
Mailing Address - Fax:
Practice Address - Street 1:1067 E BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5515
Practice Address - Country:US
Practice Address - Phone:813-548-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA