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General NPI Number Information
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NPI Number | 1790095297
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Entity Type | Organization
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Legal Business Name | A NEW BEGINNING SOBER LIVING
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 11402 AVON AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-4304
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Country | US
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Telephone | 216-641-6277
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Fax | 216-991-4320
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Provider Business Mailing Address
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Address Line | 11402 AVON AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-4304
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Country | US
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Telephone | 216-641-6277
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Fax | 216-991-4320
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CHANCE BUTTS
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Credential |
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Telephone | 216-641-6277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1457028
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License Number State | OH
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