Provider Demographics
NPI:1780373324
Name:NEW LIFE RECOVERY FOUNDATION CORP
Entity type:Organization
Organization Name:NEW LIFE RECOVERY FOUNDATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VENNIETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-908-3106
Mailing Address - Street 1:302 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3618
Mailing Address - Country:US
Mailing Address - Phone:410-304-6686
Mailing Address - Fax:443-836-9157
Practice Address - Street 1:302 PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3618
Practice Address - Country:US
Practice Address - Phone:410-304-6686
Practice Address - Fax:443-836-9157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health