Organization
NEW LIFE ADVANTAGE SUPPORT
Active
Other names
NEW LIFE
Organization subpart
No
Provider details
NPI number
Authorized official
WADE PHILLIPS (MANAGER)
(938) 888-4697
Entity
Organization
Contact information
Practice address
200 TILLARY ST, BROOKLYN, NY 11201-3010
(938) 888-4697
Mailing address
254 CLINTON AVE APT 2, JERSEY CITY, NJ 07304-1608
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
—
—
253J00000X
Foster Care Agency
Primary
—
—
Other
Enumeration date
02/04/2025
Last updated
02/04/2025
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