Organization
YOUR NEW BEGINNING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS KEITH SLOCUMB (CHEIF EXECUTIVE ADMINISTRATOR)
(910) 904-6944
Entity
Organization
Contact information
Practice address
529 HARRIS AVE, RAEFORD, NC 28376-3113
(910) 904-6944
(910) 904-2727
Mailing address
529 HARRIS AVE, RAEFORD, NC 28376-3113
(910) 904-6944
(910) 904-2727
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL 047067
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-047-107
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408061
—
NC
05
—
7805402
—
NC
05
—
8301267
—
NC
Enumeration date
01/02/2007
Last updated
10/30/2007
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