Provider Demographics
NPI:1316237076
Name:A FRESH START AND NEW BEGINNINGS
Entity type:Organization
Organization Name:A FRESH START AND NEW BEGINNINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-379-6249
Mailing Address - Street 1:4105 W VILLA LINDA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5157
Mailing Address - Country:US
Mailing Address - Phone:623-434-2126
Mailing Address - Fax:623-434-1494
Practice Address - Street 1:4105 W VILLA LINDA DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5157
Practice Address - Country:US
Practice Address - Phone:623-434-2126
Practice Address - Fax:623-434-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3871320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities