MEDICARE: NEW BEGINNINGS COMMUNITY OUTREACH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	63703	LA

General Provider Information

NPI Number	:	1023414448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BEGINNINGS COMMUNITY OUTREACH CENTER

Provider Business Mailing Address
First Line	:	1 LAKESHORE DR STE 1640E
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70629-0100
Country	:	US
Telephone Number	:	337-794-5351
Fax Number	:	337-433-4894

Provider Business Practice Location Address
First Line	:	1 LAKESHORE DR STE 1640E
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70629-0100
Country	:	US
Telephone Number	:	337-794-5351
Fax Number	:	337-433-4894

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. PATRICK ANDRE STEWARD
Credential	:	M.A.C., III
Telephone Number	:	337-794-5351

Provider Enumeration Date	:	11/12/2014
Last Update Date	:	11/12/2014

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