Organization
NEW LIFE RESIDENTIAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY GREY (RESIDENTIAL DIRECTOR)
(919) 710-0581
Entity
Organization
Contact information
Practice address
119 HILLTOP DR, FOUR OAKS, NC 27524-9686
(919) 628-3339
(919) 209-9703
Mailing address
119 HILLTOP DR, FOUR OAKS, NC 27524-9686
(919) 628-3339
(919) 209-9703
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-051-193
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/02/2011
Last updated
06/02/2011
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