Healthcare Provider Details

I. General information

NPI: 1093301848
Provider Name (Legal Business Name): NEW WAY GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 05/11/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 RAFT LN
OXNARD CA
93035-1769
US

IV. Provider business mailing address

2600 RAFT LN
OXNARD CA
93035-1769
US

V. Phone/Fax

Practice location:
  • Phone: 786-449-5610
  • Fax: 805-201-7130
Mailing address:
  • Phone: 786-449-5610
  • Fax: 805-201-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RICARDO CONTRERAS
Title or Position: HEAD OF SERVICE
Credential:
Phone: 805-201-7976