MEDICARE: NEW AGE HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility		IN

General Provider Information

NPI Number	:	1508851007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW AGE HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	303 FRANKLIN AVE
Second Line	:	P.O. BOX 589
City	:	ARCADIA
State	:	IN
Zip	:	46030-9644
Country	:	US
Telephone Number	:	317-984-9321
Fax Number	:	317-984-1620

Provider Business Practice Location Address
First Line	:	303 FRANKLIN AVE
Second Line	:
City	:	ARCADIA
State	:	IN
Zip	:	46030-9644
Country	:	US
Telephone Number	:	317-984-9321
Fax Number	:	317-984-1620

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL FEINSTEIN
Credential	:
Telephone Number	:	317-984-9321

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/16/2007

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