NEW AGE SERVICES CORPORATION NPI 1073023149

NPI Information

NPI: 1073023149
Provider Name: NEW AGE SERVICES CORPORATION

Doing Business As: NEW AGE SERVICES CORPORATION

Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

Address:
386 N YORK ST
ELMHURST, IL
ZIP 60126
Phone: (630) 501-1742
Get Directions

NEW AGE SERVICES CORPORATION is a methadone clinic center in Elmhurst, IL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. NEW AGE SERVICES CORPORATION NPI is 1073023149. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As New Age Services Corporation.

The provider's business location address is:

386 N YORK ST
ELMHURST, IL
ZIP 60126-363
Phone: (630) 501-1742
Fax: (773) 542-1175

The provider's authorized official is Ulysses Jerome Jefferson .
The authorized official title is Patient Revenue Coordinator and has the following contact phone number (773) 542-1150.

The CLIA number assigned to this NPI record is 14D1054153 - comp. outpatient rehab facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/3/2017 and was last updated on 12/20/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	A-0579-0001-A	ILLINOIS	No
2	101YP2500X	Counselor	Professional	A-0579-0001-A	ILLINOIS	No
3	103T00000X	Psychologist		16008	ILLINOIS	No
4	104100000X	Social Worker		16008	ILLINOIS	No
5	1041C0700X	Social Worker	Clinical	16008	ILLINOIS	No
6	207QA0401X	Family Medicine	Addiction Medicine	A-0579-0001-A	ILLINOIS	No
7	251S00000X	Community/Behavioral Health		16008	ILLINOIS	No
8	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	16008	ILLINOIS	No
9	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	A-0579-0001-A	ILLINOIS	No
10	276400000X	Rehabilitation, Substance Use Disorder Unit			ILLINOIS	No
11	261QM2800X	Clinic/Center	Methadone			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	333304755-60623-01	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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