Provider Demographics
NPI:1881352938
Name:NEW AGE HEALTHCARE & WELLNESS LLC
Entity type:Organization
Organization Name:NEW AGE HEALTHCARE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-561-0216
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-0854
Mailing Address - Country:US
Mailing Address - Phone:617-851-3583
Mailing Address - Fax:
Practice Address - Street 1:630 PARK ST STE 207
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3659
Practice Address - Country:US
Practice Address - Phone:508-561-0216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty