Organization
NEW LIFE COMMUNITY GROUP HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEATRICE D HARDEE (ADMINISTRATOR)
(336) 595-4501
Entity
Organization
Contact information
Practice address
2885 MARSHALLBERG STREET, WINSTON-SALEM, NC 27105
(336) 595-4501
Mailing address
2885 MARSHALLBERG STREET, WINSTON-SALEM, NC 27105
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-034-202
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408142
—
NC
Enumeration date
10/11/2006
Last updated
08/22/2020
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