1770716235 NPI number — NEW LIFE FOUNDATIONS

Table of content: PAMELA KAY STRIPLIN APN (NPI 1942258165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770716235 NPI number — NEW LIFE FOUNDATIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW LIFE FOUNDATIONS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770716235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
614 NORTH MADISION BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROXBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27573-4636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-672-0751
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5021 MILLER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27704-1877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-672-0751
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BREWSTER
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
919-672-0751

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1639338395 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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