MEDICARE: A NEW START FAMILY SERVICES, INC.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1265735625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A NEW START FAMILY SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 23006
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29224-3006
Country	:	US
Telephone Number	:	910-206-3813
Fax Number	:

Provider Business Practice Location Address
First Line	:	9005 TWO NOTCH RD STE 3
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5851
Country	:	US
Telephone Number	:	910-206-3813
Fax Number	:

Authorized Official
Title or Position	:	CEO/ EXECUTIVE DIRECTOR
Name	:	MRS. KEISHA RENEE COVINGTON
Credential	:
Telephone Number	:	910-206-3813

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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Directions to “A NEW START FAMILY SERVICES, INC. ” Practice Location

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