Provider Demographics
NPI:1134545676
Name:NEW BEGINNINGS AT LAKE CHARLES LLC
Entity type:Organization
Organization Name:NEW BEGINNINGS AT LAKE CHARLES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNIER
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?:Yes
Parent Organization LBN:NEW BEGINNINGS AT LAKE CHARLES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-07
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2183273Medicaid