Provider Demographics
NPI:1053730937
Name:NEW CREATION BEHAVIORAL HEALTHCARE FOUNDATION
Entity type:Organization
Organization Name:NEW CREATION BEHAVIORAL HEALTHCARE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:CADAC II, BS, MBA
Authorized Official - Phone:909-519-0767
Mailing Address - Street 1:333 E ARROW HWY UNIT 220
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-7008
Mailing Address - Country:US
Mailing Address - Phone:909-519-0767
Mailing Address - Fax:909-985-2316
Practice Address - Street 1:2511 S MCCARTY DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-9220
Practice Address - Country:US
Practice Address - Phone:909-519-0767
Practice Address - Fax:909-985-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility