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General NPI Number Information
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NPI Number | 1730623786
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Entity Type | Organization
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Legal Business Name | A NEW AGE HUMAN SERVICES CORP.
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Dates
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Enumeration Date | 12/10/2016
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Last Update Date | 12/10/2016
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Provider Practice Location Address
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Address Line | 5328 W PARKER AVE
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City | CHICAGO
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State | IL
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Zip | 60639-1521
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Country | US
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Telephone | 773-237-8793
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Fax | 708-575-5903
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Provider Business Mailing Address
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Address Line | 5328 W PARKER AVE
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City | CHICAGO
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State | IL
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Zip | 60639-1521
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Country | US
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Telephone | 773-237-8793
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Fax | 708-575-5903
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/QIDP/RN
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Name | CHARISSA MUNOZ-LIGO
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Credential |
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Telephone | 773-491-1480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 201500008C
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License Number State | IL
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