Healthcare Provider Details

I. General information

NPI: 1700233145
Provider Name (Legal Business Name): NEW BEGINNINGS C-STAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 N KINGSHIGHWAY BLVD STE 4
SAINT LOUIS MO
63113-1426
US

IV. Provider business mailing address

1408 N KINGSHIGHWAY BLVD STE 4
SAINT LOUIS MO
63113-1426
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-8989
  • Fax: 314-367-2188
Mailing address:
  • Phone: 314-367-8989
  • Fax: 314-367-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAUNTAY RENEA MCCOLLOUGH
Title or Position: EXECUTIVE ASSISTANT/AP&AR
Credential: B.S.
Phone: 314-367-8989