Basic Information
| Provider Information | |||||||||
| NPI: | 1588693550 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW BEACON HEALTHCARE GROUP, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEW BEACON OF SCOTTSBORO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4060 | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281174060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046642876 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1602 S BROAD ST | ||||||||
| Address2: | |||||||||
| City: | SCOTTSBORO | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357682611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565744622 | ||||||||
| FaxNumber: | 2562593772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COMBS | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP OF LICENSURE | ||||||||
| AuthorizedOfficialTelephone: | 9138142013 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH1000X | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Hospice |
ID Information
| ID | Type | State | Issuer | Description | PIC1512E | 05 | AL | MEDICAID |