Provider Demographics
NPI:1235681701
Name:NEW BEGINNINGS RESIDENTIAL TF
Entity Type:Organization
Organization Name:NEW BEGINNINGS RESIDENTIAL TF
Other - Org Name:NEW BEGINNINGS - RAJA
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-378-1992
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92572-0207
Mailing Address - Country:US
Mailing Address - Phone:951-637-6747
Mailing Address - Fax:951-637-6758
Practice Address - Street 1:2579 SPECTACULAR BID ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571
Practice Address - Country:US
Practice Address - Phone:951-943-5480
Practice Address - Fax:951-637-6758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW BEGINNING RESIDENTIAL TREATMENT FACILITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-31
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336403968322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children