Provider Demographics
NPI:1629737929
Name:NEW AGE COMMUNITY BASED ADULT SERVICES INC.
Entity Type:Organization
Organization Name:NEW AGE COMMUNITY BASED ADULT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GHUKASIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-731-4990
Mailing Address - Street 1:780 GREENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-4203
Mailing Address - Country:US
Mailing Address - Phone:626-731-4990
Mailing Address - Fax:323-544-2923
Practice Address - Street 1:780 GREENRIDGE DR
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-4203
Practice Address - Country:US
Practice Address - Phone:626-731-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care