Provider Demographics
NPI:1700233145
Name:NEW BEGINNINGS C-STAR
Entity Type:Organization
Organization Name:NEW BEGINNINGS C-STAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT/AP&AR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNTAY
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:MCCOLLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:314-367-8989
Mailing Address - Street 1:1408 N KINGSHIGHWAY BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-1426
Mailing Address - Country:US
Mailing Address - Phone:314-367-8989
Mailing Address - Fax:314-367-2188
Practice Address - Street 1:1408 N KINGSHIGHWAY BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-1426
Practice Address - Country:US
Practice Address - Phone:314-367-8989
Practice Address - Fax:314-367-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder