1467900514 NPI number — NEW BEGINNINGS DRUG TREATMENT CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467900514 NPI number — NEW BEGINNINGS DRUG TREATMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BEGINNINGS DRUG TREATMENT CENTER
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:
1467900514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4855 MACCORKLE AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25309-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-720-4444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5257 BIG TYLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSS LANES
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25313-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-720-4444
Provider Business Practice Location Address Fax Number:
646-839-2999
Provider Enumeration Date:
09/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MUCKLOW
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-720-4444

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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