Provider Demographics
NPI:1346469509
Name:NEW BEGINNINGS YOUTH FACILITY
Entity Type:Organization
Organization Name:NEW BEGINNINGS YOUTH FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMESHA
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:SPINKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-302-0801
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:2106 NEWELL ST.
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-0157
Mailing Address - Country:US
Mailing Address - Phone:336-824-3314
Mailing Address - Fax:
Practice Address - Street 1:2106 NEWELL STREET
Practice Address - Street 2:
Practice Address - City:RAMSEUR
Practice Address - State:NC
Practice Address - Zip Code:27316-0157
Practice Address - Country:US
Practice Address - Phone:336-824-3314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC076069322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408451OtherCAP PROVIDER NUMBER
NC030859OtherMHL -076069
NC6603708Medicaid