Provider Demographics
NPI:1295479244
Name:THE NEWSTART INTEGRATED HEALTH CLINIC LLC
Entity type:Organization
Organization Name:THE NEWSTART INTEGRATED HEALTH CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANALIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE PEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-358-9175
Mailing Address - Street 1:15213 N 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8542
Mailing Address - Country:US
Mailing Address - Phone:602-358-9175
Mailing Address - Fax:
Practice Address - Street 1:2920 N 24TH AVE STE 120&130
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5947
Practice Address - Country:US
Practice Address - Phone:602-358-9175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty