Healthcare Provider Details

I. General information

NPI: 1437692639
Provider Name (Legal Business Name): NEW AGE SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S KOSTNER AVE
CHICAGO IL
60623-1152
US

IV. Provider business mailing address

1330 S KOSTNER AVE
CHICAGO IL
60623-1152
US

V. Phone/Fax

Practice location:
  • Phone: 773-542-1150
  • Fax:
Mailing address:
  • Phone: 773-542-1150
  • Fax: 773-542-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. TONYIA P WINSTON
Title or Position: CEO
Credential: PHD
Phone: 773-542-1150