Provider Demographics
NPI:1043200801
Name:NEW AGE MEDICAL
Entity Type:Organization
Organization Name:NEW AGE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:IHEMADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-676-9383
Mailing Address - Street 1:15342 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2152
Mailing Address - Country:US
Mailing Address - Phone:310-676-9383
Mailing Address - Fax:310-644-0652
Practice Address - Street 1:15342 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2152
Practice Address - Country:US
Practice Address - Phone:310-676-9383
Practice Address - Fax:310-644-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101131332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1243880001Medicare ID - Type Unspecified