Provider Demographics
NPI:1558355834
Name:THE NEW FOUNDATION
Entity Type:Organization
Organization Name:THE NEW FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-945-3302
Mailing Address - Street 1:1200 N 77TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3708
Mailing Address - Country:US
Mailing Address - Phone:480-945-3302
Mailing Address - Fax:480-945-9308
Practice Address - Street 1:1200 N 77TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3708
Practice Address - Country:US
Practice Address - Phone:480-945-3302
Practice Address - Fax:480-945-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-829322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ598047Medicaid