Provider Demographics
NPI:1871998492
Name:NEW AGE ENTERPRISES
Entity type:Organization
Organization Name:NEW AGE ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-613-6081
Mailing Address - Street 1:817 W BEVERLY BLVD
Mailing Address - Street 2:SUITE #206
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4251
Mailing Address - Country:US
Mailing Address - Phone:323-278-0995
Mailing Address - Fax:323-297-5266
Practice Address - Street 1:817 W BEVERLY BLVD STE 206
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4265
Practice Address - Country:US
Practice Address - Phone:323-278-0995
Practice Address - Fax:323-297-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002837251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550002837OtherSTATE LICENSE