MEDICARE: COMMENCEMENTS: A NEW BEGINNING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1366642084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMENCEMENTS: A NEW BEGINNING

Provider Business Mailing Address
First Line	:	6236 LUMBER RIVER CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6649
Country	:	US
Telephone Number	:	702-632-3446
Fax Number	:	702-632-3446

Provider Business Practice Location Address
First Line	:	6236 LUMBER RIVER CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6649
Country	:	US
Telephone Number	:	702-632-3446
Fax Number	:	702-632-3446

Authorized Official
Title or Position	:	FOUNDER
Name	:	MRS. KIMBERELY ANN GRISBY
Credential	:
Telephone Number	:	702-632-3446

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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Directions to “COMMENCEMENTS: A NEW BEGINNING ” Practice Location

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