Provider Demographics
NPI:1710420682
Name:NEW AGE HEALING CENTER, INC.
Entity Type:Organization
Organization Name:NEW AGE HEALING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUSEBIO
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-830-8193
Mailing Address - Street 1:8408 WILSKY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1515
Mailing Address - Country:US
Mailing Address - Phone:813-374-5887
Mailing Address - Fax:813-374-6225
Practice Address - Street 1:8408 WILSKY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1515
Practice Address - Country:US
Practice Address - Phone:813-374-5887
Practice Address - Fax:813-374-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty