Provider Demographics
NPI:1417227554
Name:NEW AGE ENTERPRISES
Entity Type:Organization
Organization Name:NEW AGE ENTERPRISES
Other - Org Name:MANALE OCCUPATIONAL & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER/HR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:REGIONAL MANAGER/HR
Authorized Official - Phone:562-927-5820
Mailing Address - Street 1:817 W BEVERLY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4265
Mailing Address - Country:US
Mailing Address - Phone:562-927-5820
Mailing Address - Fax:562-684-0102
Practice Address - Street 1:7320 FIRESTONE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4159
Practice Address - Country:US
Practice Address - Phone:562-927-5820
Practice Address - Fax:562-684-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2080P0006X
CAOT 4566225X00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA521108Medicaid