Healthcare Provider Details

I. General information

NPI: 1669594883
Provider Name (Legal Business Name): A NEW BEGINNING ADULT AND YOUTH SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 RALEIGH ST STE A
HAMLET NC
28345-2757
US

IV. Provider business mailing address

112 RALEIGH ST STE A
HAMLET NC
28345-2757
US

V. Phone/Fax

Practice location:
  • Phone: 910-582-2300
  • Fax: 910-582-2288
Mailing address:
  • Phone: 910-582-2300
  • Fax: 910-582-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: THOMAS LEONARD POWE
Title or Position: CEO
Credential:
Phone: 704-694-8316