Healthcare Provider Details

I. General information

NPI: 1538090881
Provider Name (Legal Business Name): NEW BETHEL COMMUNITY RESTORATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LITTLE ROCK RD
CHARLOTTE NC
28214-2317
US

IV. Provider business mailing address

1520 LITTLE ROCK RD
CHARLOTTE NC
28214-2317
US

V. Phone/Fax

Practice location:
  • Phone: 704-352-9591
  • Fax:
Mailing address:
  • Phone: 704-352-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANIE ADAMS
Title or Position: FOUNDER
Credential: PAC
Phone: 704-352-9591