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General NPI Number Information
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NPI Number | 1356654503
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Entity Type | Organization
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Legal Business Name | NEW BEGINNINGS
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 1119 BURTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-3367
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Country | US
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Telephone | 616-632-4407
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Fax |
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Provider Business Mailing Address
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Address Line | 4490 SPRINGMONT DR SE
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City | KENTWOOD
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State | MI
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Zip | 49512-5372
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Country | US
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Telephone | 616-632-4407
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Fax |
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Authorized Official
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Title or Position | CARE COORDINATOR
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Name | MELANIE NICOLE DAVIS
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Credential | BSW
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Telephone | 616-632-4407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 6802086484
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License Number State | MI
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