| New Life, Llc | |
|
11030 Warwick Blvd Bldg B Newport News VA 23601-3250 | |
| (757) 595-3890 | |
| (757) 595-3891 |
| Full Name | New Life, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 11030 Warwick Blvd Bldg B, Newport News, Virginia |
| Authorized Official Name and Position | Richard E Roman (CAO) |
| Authorized Official Contact | 7575953890 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Life, Llc 11030 Warwick Blvd Bldg B Newport News VA 23601-3250 Ph: (757) 595-3890 | New Life, Llc 11030 Warwick Blvd Bldg B Newport News VA 23601-3250 Ph: (757) 595-3890 |
| NPI Number | 1710234240 |
|---|---|
| Provider Enumeration Date | 08/15/2012 |
| Last Update Date | 08/20/2020 |
| Certification Date | 08/20/2020 |
| Medicare PECOS PAC ID | 2163765512 |
|---|---|
| Medicare Enrollment ID | O20190528002014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710234240 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1729 (Virginia) | Primary |
| Provider Name | Carla Elizabeth Randolph |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407302573 PECOS PAC ID: 4082035753 Enrollment ID: I20200605000447 |
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