Healthcare Provider Details

I. General information

NPI: 1144672262
Provider Name (Legal Business Name): OUR NEW BEGINNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8633 N HIGHWAY 17
MC CLELLANVILLE SC
29458-9470
US

IV. Provider business mailing address

8633 N HIGHWAY 17
MC CLELLANVILLE SC
29458-9470
US

V. Phone/Fax

Practice location:
  • Phone: 843-834-2426
  • Fax:
Mailing address:
  • Phone: 843-834-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberRN40136
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVELYN MIDDLETON-FRASIER
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 843-834-2426