Provider Demographics
NPI:1912136144
Name:NEW LIFE CHILDREN'S HOME
Entity type:Organization
Organization Name:NEW LIFE CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:870-217-9125
Mailing Address - Street 1:PO BOX 885
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-0885
Mailing Address - Country:US
Mailing Address - Phone:870-264-3757
Mailing Address - Fax:870-264-9300
Practice Address - Street 1:50 4TH ST
Practice Address - Street 2:
Practice Address - City:OIL TROUGH
Practice Address - State:AR
Practice Address - Zip Code:72564
Practice Address - Country:US
Practice Address - Phone:870-264-3757
Practice Address - Fax:870-264-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR20128322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children