MEDICARE: NEW BEGINNINGS SUBSTANCE ABUSE 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	3245S0500X	Children's Substance Abuse Rehabilitation Facility	4280	TX
2	324500000X	Substance Abuse Rehabilitation Facility	4280	TX

General Provider Information

NPI Number	:	1770086290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BEGINNINGS SUBSTANCE ABUSE SERVICES, INC

Provider Business Mailing Address
First Line	:	200 E INTERSTATE 2 STE O
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-6506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E INTERSTATE 2 STE O
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-6506
Country	:	US
Telephone Number	:	956-231-0371
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ISHMAEL AVILA
Credential	:
Telephone Number	:	956-231-0371

Provider Enumeration Date	:	03/11/2018
Last Update Date	:	03/11/2018

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