Provider Demographics
NPI:1932933603
Name:TS NEW LIFE LLC
Entity type:Organization
Organization Name:TS NEW LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATOIS
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:402-871-2952
Mailing Address - Street 1:323 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1676
Mailing Address - Country:US
Mailing Address - Phone:402-871-2952
Mailing Address - Fax:
Practice Address - Street 1:25 S 15TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3900
Practice Address - Country:US
Practice Address - Phone:402-871-2952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services