Healthcare Provider Details

I. General information

NPI: 1639337090
Provider Name (Legal Business Name): NEW BEGINNINGS RESOURCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2008
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 TULSA DR
GREENSBORO NC
27406-6341
US

IV. Provider business mailing address

4106 TULSA DR
GREENSBORO NC
27406-6341
US

V. Phone/Fax

Practice location:
  • Phone: 336-547-6637
  • Fax: 336-547-6637
Mailing address:
  • Phone: 336-547-6637
  • Fax: 336-547-6637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-041-869
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-041-869
License Number StateNC

VIII. Authorized Official

Name: MR. NATHANIEL LEWIS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 336-457-9034