Healthcare Provider Details

I. General information

NPI: 1639640915
Provider Name (Legal Business Name): NEW BEGINNINGS GROUP HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 S 100TH DR
TOLLESON AZ
85353-8434
US

IV. Provider business mailing address

3109 S 100TH DR
TOLLESON AZ
85353-8434
US

V. Phone/Fax

Practice location:
  • Phone: 602-733-9285
  • Fax:
Mailing address:
  • Phone: 602-733-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KASSINDA KING BAYO
Title or Position: OWNER
Credential:
Phone: 602-733-9285