New Life Community Group Home, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

MHL-034-202 Issued in NC

Legal business name

NEW LIFE COMMUNITY GROUP HOME, INC.

Practice address

2885 Marshallberg Street
Winston-Salem, NC 27105

Phone

(336) 595-4501

NPI assigned

Oct 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Beatrice D Hardee

Title

Administrator

Phone

(336) 595-4501

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194814038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2885 MARSHALLBERG STREET",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2885 MARSHALLBERG STREET",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27105",
            "telephone_number": "336-595-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LIFE COMMUNITY GROUP HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARDEE",
        "authorized_official_first_name": "BEATRICE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-595-4501"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-034-202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408142",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Charles G New, DDS MS PA
• Heidi Rebecca Newkirk, DPM

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.