Healthcare Provider Details

I. General information

NPI: 1962127902
Provider Name (Legal Business Name): NEW WAY GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 RAFT LN
OXNARD CA
93035-1225
US

IV. Provider business mailing address

2446 WOODPECKER AVE
VENTURA CA
93003-7138
US

V. Phone/Fax

Practice location:
  • Phone: 805-201-0529
  • Fax:
Mailing address:
  • Phone: 805-201-0529
  • Fax:

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