1780041343 NPI number — NEW BEGINNINGS BEHAVIORAL HEALTH, LLC

Table of content: (NPI 1780041343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780041343 NPI number — NEW BEGINNINGS BEHAVIORAL HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BEGINNINGS BEHAVIORAL HEALTH, LLC
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:
1780041343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4410 CLAIBORNE SQ E
Provider Second Line Business Mailing Address:
ST 334
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-2071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-268-2891
Provider Business Mailing Address Fax Number:
855-898-1313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 CLAIBORNE SQ E
Provider Second Line Business Practice Location Address:
ST 334
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-2071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-268-2891
Provider Business Practice Location Address Fax Number:
855-898-1313
Provider Enumeration Date:
01/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JEREMIAH
Authorized Official Middle Name:
Authorized Official Title or Position:
LCSW
Authorized Official Telephone Number:
757-268-2891

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0904002584 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1508015124 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1508015124 . This is a "VA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "ANTHEM EAP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "ANTHEM BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "MILITARY ONE SOURCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "ANTHEM HEALTH KEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508015124 . This is a "COMPSYCH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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