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General NPI Number Information
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NPI Number | 1730404112
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Entity Type | Organization
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Legal Business Name | FRESH BEGINNINGS
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 72 W 11TH ST SUITE A
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City | TRACY
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State | CA
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Zip | 95376-3906
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Country | US
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Telephone | 209-830-7400
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Fax | 209-833-8386
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Provider Business Mailing Address
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Address Line | 1852 W 11TH ST
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City | TRACY
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State | CA
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Zip | 95376-3736
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Country | US
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Telephone | 209-830-7400
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Fax | 209-833-8386
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Authorized Official
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Title or Position | DIRECTOR/CEO
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Name | DR. VALERIE ELAINE SIMS
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Credential |
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Telephone | 209-830-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 390031AN
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License Number State | CA
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