Provider Demographics
NPI:1417388877
Name:NEW AGE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:NEW AGE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TRIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:678-361-1979
Mailing Address - Street 1:6504 FOLKSTONE AVE
Mailing Address - Street 2:UNIT 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-7023
Mailing Address - Country:US
Mailing Address - Phone:678-361-1979
Mailing Address - Fax:
Practice Address - Street 1:6767 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9073
Practice Address - Country:US
Practice Address - Phone:678-361-1979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health