MEDICARE: NEW BEGINNINGS RECOVERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	OTP0094	SC

General Provider Information

NPI Number	:	1811327745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BEGINNINGS RECOVERY CENTER LLC

Provider Business Mailing Address
First Line	:	1417 GREGG ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3527
Country	:	US
Telephone Number	:	803-758-2445
Fax Number	:	803-758-2447

Provider Business Practice Location Address
First Line	:	1417 GREGG ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3527
Country	:	US
Telephone Number	:	803-758-2445
Fax Number	:	803-758-2447

Authorized Official
Title or Position	:	PROGRAM DIRECTOR, OWNER
Name	:	MS. LISA NORDLUND
Credential	:	CAC II
Telephone Number	:	803-758-2445

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	11/13/2013

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