1063647881 NPI number — NEW BEGINNINGS FAMILY SERVICES

Table of content: (NPI 1063647881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063647881 NPI number — NEW BEGINNINGS FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BEGINNINGS FAMILY SERVICES
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:
1063647881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
713 E LEXINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOCKSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27028-2623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-936-0029
Provider Business Mailing Address Fax Number:
336-936-0039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
713 E LEXINGTON RD APT 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOCKSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27028-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-936-0029
Provider Business Practice Location Address Fax Number:
336-936-0039
Provider Enumeration Date:
05/22/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KLASS
Authorized Official First Name:
BECKY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
336-936-0029

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL030019 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6604105 . This is a "PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".