Healthcare Provider Details

I. General information

NPI: 1407792799
Provider Name (Legal Business Name): A BRAND NEW START HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 E NC 150 HWY STE 103
LINCOLNTON NC
28092
US

IV. Provider business mailing address

3514 E NC 150 HWY STE 103
LINCOLNTON NC
28092
US

V. Phone/Fax

Practice location:
  • Phone: 704-974-0669
  • Fax: 704-974-0669
Mailing address:
  • Phone: 704-974-0669
  • Fax: 704-974-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ERNEST OSEI KOKOFU JR.
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 704-974-0669