Provider Demographics
NPI:1104462241
Name:NEW LIFE HOME CARE LLC
Entity type:Organization
Organization Name:NEW LIFE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYRELL
Authorized Official - Middle Name:LETWAN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-351-3903
Mailing Address - Street 1:2703 TROTTER RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-8211
Mailing Address - Country:US
Mailing Address - Phone:803-708-4088
Mailing Address - Fax:
Practice Address - Street 1:4423 DEVINE ST STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3611
Practice Address - Country:US
Practice Address - Phone:803-708-4088
Practice Address - Fax:803-451-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care