Provider Demographics
NPI:1063110914
Name:NEW BEGINNINGS SUPPORTIVE SERVICES, LLC
Entity type:Organization
Organization Name:NEW BEGINNINGS SUPPORTIVE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FAYESHON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-479-1677
Mailing Address - Street 1:6449 BAREBACK TER
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4196
Mailing Address - Country:US
Mailing Address - Phone:804-479-1677
Mailing Address - Fax:
Practice Address - Street 1:6449 BAREBACK TER
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-4196
Practice Address - Country:US
Practice Address - Phone:804-479-1677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No251S00000XAgenciesCommunity/Behavioral Health