Provider Demographics
NPI:1235549791
Name:A NEW BEGINNING WELLNES CENTER
Entity Type:Organization
Organization Name:A NEW BEGINNING WELLNES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARL
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:208-939-3865
Mailing Address - Street 1:8660 W EMERALD ST
Mailing Address - Street 2:SUITE 142
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4825
Mailing Address - Country:US
Mailing Address - Phone:208-939-3865
Mailing Address - Fax:208-939-3869
Practice Address - Street 1:8660 W EMERALD ST
Practice Address - Street 2:SUITE 142
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4825
Practice Address - Country:US
Practice Address - Phone:208-939-3865
Practice Address - Fax:208-939-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID37406251S00000X
ID37046253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Yes251S00000XAgenciesCommunity/Behavioral Health