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General NPI Number Information
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NPI Number | 1871998492
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Entity Type | Organization
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Legal Business Name | NEW AGE ENTERPRISES
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 817 W BEVERLY BLVD STE 206
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City | MONTEBELLO
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State | CA
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Zip | 90640-4265
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Country | US
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Telephone | 323-278-0995
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Fax | 323-297-5266
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Provider Business Mailing Address
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Address Line | 817 W BEVERLY BLVD SUITE #206
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City | MONTEBELLO
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State | CA
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Zip | 90640-4251
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Country | US
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Telephone | 323-278-0995
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Fax | 323-297-5266
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | MELISSA LIMON
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Credential |
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Telephone | 323-613-6081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 550002837
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License Number State | CA
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