Provider Demographics
NPI:1194342691
Name:NEW LIFE CLINICAL SERVICES OF VIRGINIA CORP
Entity type:Organization
Organization Name:NEW LIFE CLINICAL SERVICES OF VIRGINIA CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:SUBSTANCE ABUSE ED
Authorized Official - Phone:804-276-6767
Mailing Address - Street 1:PO BOX 74434
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-0008
Mailing Address - Country:US
Mailing Address - Phone:804-276-6767
Mailing Address - Fax:
Practice Address - Street 1:2501 TURNER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23224-2537
Practice Address - Country:US
Practice Address - Phone:804-276-6767
Practice Address - Fax:804-655-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty