Provider Demographics
NPI:1730623786
Name:A NEW AGE HUMAN SERVICES CORP.
Entity type:Organization
Organization Name:A NEW AGE HUMAN SERVICES CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/QIDP/RN
Authorized Official - Prefix:
Authorized Official - First Name:CHARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ-LIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-491-1480
Mailing Address - Street 1:5328 W PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1521
Mailing Address - Country:US
Mailing Address - Phone:773-237-8793
Mailing Address - Fax:708-575-5903
Practice Address - Street 1:5328 W PARKER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1521
Practice Address - Country:US
Practice Address - Phone:773-237-8793
Practice Address - Fax:708-575-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201500008C320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities