Provider Demographics
NPI:1588269310
Name:NEW BREED CREATION LIFE CENTER, INC.
Entity type:Organization
Organization Name:NEW BREED CREATION LIFE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING & CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-300-7494
Mailing Address - Street 1:7035 PHILIPS HWY STE 11
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6071
Mailing Address - Country:US
Mailing Address - Phone:904-253-3429
Mailing Address - Fax:
Practice Address - Street 1:7035 PHILIPS HWY STE 11
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6071
Practice Address - Country:US
Practice Address - Phone:904-253-3429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health