Provider Demographics
NPI:1619356110
Name:NEW BEGINNINGS HUMANS SERVICES# 2
Entity Type:Organization
Organization Name:NEW BEGINNINGS HUMANS SERVICES# 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOM- SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D
Authorized Official - Phone:310-671-1447
Mailing Address - Street 1:405 W MANCHESTER BLVD
Mailing Address - Street 2:#105
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1196
Mailing Address - Country:US
Mailing Address - Phone:310-671-1447
Mailing Address - Fax:310-671-1444
Practice Address - Street 1:616 E AVENUE K
Practice Address - Street 2:#105
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4740
Practice Address - Country:US
Practice Address - Phone:661-206-3691
Practice Address - Fax:661-206-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01764704Medicaid