Provider Demographics
NPI:1992865240
Name:NEW LIFE OF WEST PALM, INC
Entity type:Organization
Organization Name:NEW LIFE OF WEST PALM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-985-4065
Mailing Address - Street 1:3767 LAKE WORTH RD
Mailing Address - Street 2:102
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4048
Mailing Address - Country:US
Mailing Address - Phone:786-985-4065
Mailing Address - Fax:786-985-4065
Practice Address - Street 1:3767 LAKE WORTH RD
Practice Address - Street 2:102
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4048
Practice Address - Country:US
Practice Address - Phone:786-985-4065
Practice Address - Fax:786-985-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5461261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center