| New Life 360 Inc. | |
|
1047 E Brandon Blvd Brandon FL 33511-5515 | |
| (813) 548-1166 | |
| Not Available |
| Full Name | New Life 360 Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1047 E Brandon Blvd, Brandon, Florida |
| Authorized Official Name and Position | Sherry Bradley (CEO) |
| Authorized Official Contact | 7346585055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Life 360 Inc. 1047 E Brandon Blvd Brandon FL 33511-5515 Ph: (813) 548-1166 | New Life 360 Inc. 1047 E Brandon Blvd Brandon FL 33511-5515 Ph: (813) 548-1166 |
| NPI Number | 1194205542 |
|---|---|
| Provider Enumeration Date | 08/15/2018 |
| Last Update Date | 10/30/2019 |
| Medicare PECOS PAC ID | 2264865393 |
|---|---|
| Medicare Enrollment ID | O20191204001129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194205542 | NPI | - | NPPES |
| Provider Name | Sherry J Bradley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811254089 PECOS PAC ID: 3173956208 Enrollment ID: I20191210000056 |
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