Provider Demographics
NPI:1578893699
Name:GROUP HOME SUPPORT SERVICES
Entity Type:Organization
Organization Name:GROUP HOME SUPPORT SERVICES
Other - Org Name:NEW BEGINNINGS ADDICTION & RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HEASTON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:909-224-3942
Mailing Address - Street 1:245 NORTH MURRAY STREET
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-5528
Mailing Address - Country:US
Mailing Address - Phone:951-849-8812
Mailing Address - Fax:951-755-8915
Practice Address - Street 1:245 NORTH MURRAY STREET
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5528
Practice Address - Country:US
Practice Address - Phone:951-849-8812
Practice Address - Fax:951-755-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QMO801X261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)