Provider Demographics
NPI:1447551965
Name:NEW DIMENSION GROUP
Entity type:Organization
Organization Name:NEW DIMENSION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLATIDOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-289-2610
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28458-0880
Mailing Address - Country:US
Mailing Address - Phone:910-289-2610
Mailing Address - Fax:910-289-4410
Practice Address - Street 1:416 WEST RIDGE ST.
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458
Practice Address - Country:US
Practice Address - Phone:910-289-2610
Practice Address - Fax:910-289-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health