Provider Demographics
NPI:1548851991
Name:NEWLIFE HOMES LLC
Entity type:Organization
Organization Name:NEWLIFE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAKWAVU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-578-9062
Mailing Address - Street 1:10227 MASON AVE APT 116
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3352
Mailing Address - Country:US
Mailing Address - Phone:818-578-9062
Mailing Address - Fax:
Practice Address - Street 1:9212 PALUXY DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4949
Practice Address - Country:US
Practice Address - Phone:818-578-9062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health