Provider Demographics
NPI:1790095297
Name:A NEW BEGINNING SOBER LIVING
Entity Type:Organization
Organization Name:A NEW BEGINNING SOBER LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-641-6277
Mailing Address - Street 1:11402 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4304
Mailing Address - Country:US
Mailing Address - Phone:216-641-6277
Mailing Address - Fax:216-991-4320
Practice Address - Street 1:11402 AVON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4304
Practice Address - Country:US
Practice Address - Phone:216-641-6277
Practice Address - Fax:216-991-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1457028324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility