Provider Demographics
NPI:1619281813
Name:NEWBEGINNINGS MATERNAL AND INFANT SUPPORT
Entity Type:Organization
Organization Name:NEWBEGINNINGS MATERNAL AND INFANT SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:313-459-1869
Mailing Address - Street 1:24610 WALDEN RD W
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3111
Mailing Address - Country:US
Mailing Address - Phone:313-459-1869
Mailing Address - Fax:
Practice Address - Street 1:1119 BURTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3367
Practice Address - Country:US
Practice Address - Phone:313-459-1869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)