Healthcare Provider Details

I. General information

NPI: 1982110268
Provider Name (Legal Business Name): NEW DYNAMIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 LIPAN RD 105
HOUSTON TX
77063
US

IV. Provider business mailing address

9101 LIPAN RD 105
HOUSTON TX
77063
US

V. Phone/Fax

Practice location:
  • Phone: 281-686-6132
  • Fax:
Mailing address:
  • Phone: 281-686-6132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: GOODNEWS BONAGE
Title or Position: C.E.O.
Credential:
Phone: 281-686-6132