=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144672262
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUR NEW BEGINNING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2016
-----------------------------------------------------
Last Update Date | 07/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8633 N HIGHWAY 17
-----------------------------------------------------
City | MC CLELLANVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29458-9470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-834-2426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8633 N HIGHWAY 17
-----------------------------------------------------
City | MC CLELLANVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29458-9470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-834-2426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED NURSE
-----------------------------------------------------
Name | MRS. EVELYN MIDDLETON-FRASIER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 843-834-2426
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | RN40136
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------