Provider Demographics
NPI:1164132304
Name:NEW BEGINNING SUPPORT COORDINATION
Entity Type:Organization
Organization Name:NEW BEGINNING SUPPORT COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COKER
Authorized Official - Middle Name:D
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-456-1449
Mailing Address - Street 1:31 S BROWNING AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1109
Mailing Address - Country:US
Mailing Address - Phone:609-456-1449
Mailing Address - Fax:
Practice Address - Street 1:31 S BROWNING AVE
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-1109
Practice Address - Country:US
Practice Address - Phone:609-456-1449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0658367Medicaid