Provider Demographics
NPI:1326478413
Name:NEW BEGINNING HOME HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:NEW BEGINNING HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COUNTESS
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-536-4783
Mailing Address - Street 1:925 EAST ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:LAKE
Mailing Address - Zip Code:32778
Mailing Address - Country:UM
Mailing Address - Phone:352-508-5915
Mailing Address - Fax:352-508-5916
Practice Address - Street 1:925 E ALFRED ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3401
Practice Address - Country:US
Practice Address - Phone:352-508-5915
Practice Address - Fax:352-508-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL004611800251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004611800Medicaid