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General NPI Number Information
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NPI Number | 1619281813
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Entity Type | Organization
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Legal Business Name | NEWBEGINNINGS MATERNAL AND INFANT SUPPORT
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 1119 BURTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-3367
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Country | US
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Telephone | 313-459-1869
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Fax |
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Provider Business Mailing Address
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Address Line | 24610 WALDEN RD W
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3111
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Country | US
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Telephone | 313-459-1869
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Fax |
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Authorized Official
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Title or Position | COORDINATOR
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Name | LATONYA M RICHARDSON
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Credential | LLPC
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Telephone | 313-459-1869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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