Provider Demographics
NPI:1093523987
Name:NEW DYNAMICS BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:NEW DYNAMICS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:480-619-9463
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85001-1447
Mailing Address - Country:US
Mailing Address - Phone:480-619-9463
Mailing Address - Fax:
Practice Address - Street 1:1203 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:480-619-9463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility