Healthcare Provider Details

I. General information

NPI: 1225613706
Provider Name (Legal Business Name): BEAUTIFUL BEGINNINGS SERVICES. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 STONYPOINTE DR
GREENSBORO NC
27406-5421
US

IV. Provider business mailing address

3205 STONYPOINTE DR
GREENSBORO NC
27406-5421
US

V. Phone/Fax

Practice location:
  • Phone: 336-470-1712
  • Fax:
Mailing address:
  • Phone: 336-470-1712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: STEPHON DIONTE WILKERSON
Title or Position: OWNER
Credential:
Phone: 336-470-1712