Provider Demographics
NPI:1417100801
Name:NEW BEGINNINGS AT LAKE CHARLES, LLC
Entity Type:Organization
Organization Name:NEW BEGINNINGS AT LAKE CHARLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-855-9773
Mailing Address - Street 1:145 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-4641
Mailing Address - Country:US
Mailing Address - Phone:337-855-9773
Mailing Address - Fax:337-855-9776
Practice Address - Street 1:145 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-4641
Practice Address - Country:US
Practice Address - Phone:337-855-9773
Practice Address - Fax:337-855-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASA0007829324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility