Provider Demographics
NPI:1942533849
Name:NEW BEGINNING RESIDENTIAL SERVICES, LLC
Entity Type:Organization
Organization Name:NEW BEGINNING RESIDENTIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-651-6890
Mailing Address - Street 1:9608 HONEY TER
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3298
Mailing Address - Country:US
Mailing Address - Phone:804-651-6890
Mailing Address - Fax:
Practice Address - Street 1:9608 HONEY TER
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3298
Practice Address - Country:US
Practice Address - Phone:804-651-6890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1167-01-001320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities