Provider Demographics
NPI:1033829478
Name:AGELESS HEALTH GROUP, A PROFESSIONAL CORP NURSING
Entity Type:Organization
Organization Name:AGELESS HEALTH GROUP, A PROFESSIONAL CORP NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:YENITZA
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:909-435-4707
Mailing Address - Street 1:703 E E ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3820
Mailing Address - Country:US
Mailing Address - Phone:909-435-4707
Mailing Address - Fax:
Practice Address - Street 1:703 E E ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-3820
Practice Address - Country:US
Practice Address - Phone:909-435-4707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric