Healthcare Provider Details

I. General information

NPI: 1235997321
Provider Name (Legal Business Name): HOUSE OF NEW BEGINNINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 GARDENDALE AVE
DAYTON OH
45417-9618
US

IV. Provider business mailing address

4615 GARDENDALE AVE
DAYTON OH
45417-9618
US

V. Phone/Fax

Practice location:
  • Phone: 937-270-8755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARKITA WOODALL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 937-270-8755