1619356110 NPI number — NEW BEGINNINGS HUMANS SERVICES# 2

Table of content: MS. BARANDEE LEIGH PETERSON RN (NPI 1699927202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619356110 NPI number — NEW BEGINNINGS HUMANS SERVICES# 2

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BEGINNINGS HUMANS SERVICES# 2
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619356110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 W MANCHESTER BLVD
Provider Second Line Business Mailing Address:
#105
Provider Business Mailing Address City Name:
INGLEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90301-1196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-671-1447
Provider Business Mailing Address Fax Number:
310-671-1444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 E AVENUE K
Provider Second Line Business Practice Location Address:
#105
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93535-4740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-206-3691
Provider Business Practice Location Address Fax Number:
661-206-9662
Provider Enumeration Date:
05/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ODOM- SIMS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ PROGRAM DIRECTOR
Authorized Official Telephone Number:
310-671-1447

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01764704 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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