Healthcare Provider Details

I. General information

NPI: 1558355834
Provider Name (Legal Business Name): THE NEW FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 77TH ST
SCOTTSDALE AZ
85257-3708
US

IV. Provider business mailing address

1200 N 77TH ST
SCOTTSDALE AZ
85257-3708
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-3302
  • Fax: 480-945-9308
Mailing address:
  • Phone: 480-945-3302
  • Fax: 480-945-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberBH-829
License Number StateAZ

VIII. Authorized Official

Name: MRS. JEWEL D. OWENS
Title or Position: PRESIDENT
Credential: LCSW
Phone: 480-945-3302