Healthcare Provider Details

I. General information

NPI: 1477172377
Provider Name (Legal Business Name): NEW ROADS HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 E UNION HILLS DR
PHOENIX AZ
85050-3430
US

IV. Provider business mailing address

2906 E UNION HILLS DR
PHOENIX AZ
85050-3430
US

V. Phone/Fax

Practice location:
  • Phone: 602-699-4536
  • Fax:
Mailing address:
  • Phone: 602-699-4536
  • Fax: 803-265-0563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE PINLAC
Title or Position: CNP
Credential: MSN, APRN
Phone: 602-699-4536