Provider Demographics
NPI:1518024322
Name:YOUR NEW BEGINNING
Entity type:Organization
Organization Name:YOUR NEW BEGINNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SLOCUMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-904-6944
Mailing Address - Street 1:529 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3113
Mailing Address - Country:US
Mailing Address - Phone:910-904-6944
Mailing Address - Fax:910-904-2727
Practice Address - Street 1:529 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3113
Practice Address - Country:US
Practice Address - Phone:910-904-6944
Practice Address - Fax:910-904-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-047-107320600000X
NCMHL 047067320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805402Medicaid
NC8301267Medicaid
NC3408061Medicaid