Healthcare Provider Details

I. General information

NPI: 1770018855
Provider Name (Legal Business Name): NEW BEGINNINGS DRUG TREATMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 MCCORKLE AVE SW NEW BEGINNINGS DRUG TREATMENT CENTER INC
SOUTH CHARLESTON WV
25309-1331
US

IV. Provider business mailing address

4855 MCCORKLE AVE SW NEW BEGINNINGS DRUG TREATMENT CENTER INC
SOUTH CHARLESTON WV
25309-1331
US

V. Phone/Fax

Practice location:
  • Phone: 304-853-3869
  • Fax: 304-853-3869
Mailing address:
  • Phone: 304-853-3869
  • Fax: 304-853-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number2017971900
License Number StateWV

VIII. Authorized Official

Name: DR. WILLIAM LEE MUCKALEW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PH.D
Phone: 681-319-1235