Provider Demographics
NPI:1457089070
Name:NEW VISION BEHAVIORAL HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:NEW VISION BEHAVIORAL HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-367-5345
Mailing Address - Street 1:4409 N 179TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-5201
Mailing Address - Country:US
Mailing Address - Phone:623-229-4755
Mailing Address - Fax:
Practice Address - Street 1:3119 N 46TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3705
Practice Address - Country:US
Practice Address - Phone:602-367-5345
Practice Address - Fax:623-321-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No305S00000XManaged Care OrganizationsPoint of Service