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General NPI Number Information
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NPI Number | 1215341649
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Entity Type | Organization
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Legal Business Name | NEW BEGINNING OF NC, LLC
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 100 WESTLAKE RD STE 100
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1660
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Country | US
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Telephone | 919-828-8330
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Fax | 919-828-8330
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Provider Business Mailing Address
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Address Line | 1813 ELKPARK DR
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City | RALEIGH
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State | NC
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Zip | 27610-5897
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Country | US
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Telephone | 919-828-8330
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Fax | 919-828-8330
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Authorized Official
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Title or Position | AFL PROVIDER / DIRECTOR
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Name | OJETTA DIONNE MILEY
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Credential |
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Telephone | 919-828-8330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 4334523
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License Number State | NC
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