1730623786 NPI number — A NEW AGE HUMAN SERVICES CORP.

Table of content: (NPI 1730623786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730623786 NPI number — A NEW AGE HUMAN SERVICES CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A NEW AGE HUMAN SERVICES CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEW AGE HUMAN SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730623786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5328 W PARKER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60639-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-237-8793
Provider Business Mailing Address Fax Number:
708-575-5903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5328 W PARKER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60639-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-237-8793
Provider Business Practice Location Address Fax Number:
708-575-5903
Provider Enumeration Date:
12/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MUNOZ-LIGO
Authorized Official First Name:
CHARISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/QIDP/RN
Authorized Official Telephone Number:
773-491-1480

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  201500008C , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com