Provider Demographics
NPI:1720716855
Name:SIMPLE BEGINNINGS LLC
Entity Type:Organization
Organization Name:SIMPLE BEGINNINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-263-9374
Mailing Address - Street 1:PO BOX 1344
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6281
Mailing Address - Country:US
Mailing Address - Phone:361-263-9374
Mailing Address - Fax:
Practice Address - Street 1:4725 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3824
Practice Address - Country:US
Practice Address - Phone:361-263-9374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health