Provider Demographics
NPI:1215341649
Name:NEW BEGINNING OF NC, LLC
Entity type:Organization
Organization Name:NEW BEGINNING OF NC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AFL PROVIDER / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OJETTA
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:MILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-828-8330
Mailing Address - Street 1:1813 ELKPARK DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5897
Mailing Address - Country:US
Mailing Address - Phone:919-828-8330
Mailing Address - Fax:919-828-8330
Practice Address - Street 1:100 WESTLAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1660
Practice Address - Country:US
Practice Address - Phone:919-828-8330
Practice Address - Fax:919-828-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4334523302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization