Healthcare Provider Details

I. General information

NPI: 1679945968
Provider Name (Legal Business Name): NEW AGE SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 07/30/2023
Certification Date: 07/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 FRANKLIN AVE
GRETNA LA
70053-2115
US

IV. Provider business mailing address

623 FRANKLIN AVE
GRETNA LA
70053-2115
US

V. Phone/Fax

Practice location:
  • Phone: 504-533-9885
  • Fax:
Mailing address:
  • Phone: 225-802-9730
  • Fax:

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. KEISHA ANINE WOODS
Title or Position: OWNER
Credential:
Phone: 225-802-9730