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General NPI Number Information
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NPI Number | 1710509252
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Entity Type | Organization
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Legal Business Name | FRESH BEGINNINGS LIFE CHANGING ORGANIZATION
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 7863 LUMBER JACK DR
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City | HOUSTON
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State | TX
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Zip | 77040-1740
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Country | US
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Telephone | 713-530-4192
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40292
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City | HOUSTON
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State | TX
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Zip | 77240-0292
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Country | US
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Telephone | 713-530-4192
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WYNNETTE WILLIAMS
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Credential |
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Telephone | 713-530-4192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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