Healthcare Provider Details

I. General information

NPI: 1093267569
Provider Name (Legal Business Name): NEW BEGINNINGS RESIDENTIAL TF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2464 SLEW OF GOLD CT
PERRIS CA
92571
US

IV. Provider business mailing address

PO BOX 207
PERRIS CA
92572-0207
US

V. Phone/Fax

Practice location:
  • Phone: 951-940-4928
  • Fax: 951-637-6758
Mailing address:
  • Phone: 951-637-6747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number336402151
License Number StateCA

VIII. Authorized Official

Name: GAIL D LACY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 951-378-1992