Healthcare Provider Details

I. General information

NPI: 1790095297
Provider Name (Legal Business Name): A NEW BEGINNING SOBER LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11402 AVON AVE
CLEVELAND OH
44105-4304
US

IV. Provider business mailing address

11402 AVON AVE
CLEVELAND OH
44105-4304
US

V. Phone/Fax

Practice location:
  • Phone: 216-641-6277
  • Fax: 216-991-4320
Mailing address:
  • Phone: 216-641-6277
  • Fax: 216-991-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1457028
License Number StateOH

VIII. Authorized Official

Name: MR. CHANCE BUTTS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 216-641-6277