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General NPI Number Information
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NPI Number | 1346511748
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Entity Type | Organization
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Legal Business Name | BLESSED NEW BEGINNINGS, LLC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 1002 WAKEFIELD DR
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City | GREENSBORO
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State | NC
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Zip | 27410-3135
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Country | US
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Telephone | 336-541-8160
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Fax | 336-541-8161
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Provider Business Mailing Address
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Address Line | PO BOX 16527
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City | GREENSBORO
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State | NC
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Zip | 27416-0527
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Country | US
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Telephone | 336-541-8160
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Fax | 336-541-8161
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Authorized Official
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Title or Position | DIRECTOR/QP
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Name | MR. BOBBY LOUIS CUNNINGHAM
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Credential |
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Telephone | 336-734-3824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-041-1039
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License Number State | NC
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