Healthcare Provider Details

I. General information

NPI: 1588693550
Provider Name (Legal Business Name): NEW BEACON HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 S BROAD ST
SCOTTSBORO AL
35768-2611
US

IV. Provider business mailing address

PO BOX 4060
MOORESVILLE NC
28117-4060
US

V. Phone/Fax

Practice location:
  • Phone: 256-574-4622
  • Fax: 256-259-3772
Mailing address:
  • Phone: 704-664-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JANET COMBS
Title or Position: VP OF LICENSURE
Credential:
Phone: 913-814-2013