Healthcare Provider Details

I. General information

NPI: 1174177497
Provider Name (Legal Business Name): NEW HOPE TRANSITIONAL LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 WEST 31ST
SAN BERNARDINO CA
92405
US

IV. Provider business mailing address

P.O. BOX 11605
SAN BERNARDINO CA
92423
US

V. Phone/Fax

Practice location:
  • Phone: 909-289-9045
  • Fax: 909-402-4181
Mailing address:
  • Phone: 909-289-9045
  • Fax: 909-402-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: HERBERT LAVERIOUS WILLIAMS
Title or Position: DIRECTOR
Credential:
Phone: 909-289-9045