1881724169 NPI number — NEW BEGINNING PEDIATRIC REHAB, INC.

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 1881724169 NPI number — NEW BEGINNING PEDIATRIC REHAB, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BEGINNING PEDIATRIC REHAB, INC.
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:
6
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:
1881724169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1343
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48347-1343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-796-8499
Provider Business Mailing Address Fax Number:
877-384-9028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9256 BENDIX RD
Provider Second Line Business Practice Location Address:
STE 105/106
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-796-8499
Provider Business Practice Location Address Fax Number:
877-384-9028
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARCHESE-KENNEDY
Authorized Official First Name:
SHARI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-796-8499

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  05556 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 06394 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X , with the licence number: 17389 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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