Provider Demographics
NPI:1013456094
Name:NEW BEGINNINGS DRUG TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:NEW BEGINNINGS DRUG TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-720-4444
Mailing Address - Street 1:4855 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1331
Mailing Address - Country:US
Mailing Address - Phone:304-720-4444
Mailing Address - Fax:646-839-2999
Practice Address - Street 1:4855 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1331
Practice Address - Country:US
Practice Address - Phone:304-720-4444
Practice Address - Fax:646-839-2999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW BEGINNINGS DRUG TREATMENT CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2017-008261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center