Provider Demographics
NPI:1073833414
Name:AGING WELL ADULT CARE CENTER, INC
Entity Type:Organization
Organization Name:AGING WELL ADULT CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-652-5847
Mailing Address - Street 1:2607 ROCKWELL RD NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-3829
Mailing Address - Country:US
Mailing Address - Phone:256-652-5847
Mailing Address - Fax:
Practice Address - Street 1:2607 ROCKWELL RD NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3829
Practice Address - Country:US
Practice Address - Phone:256-652-5847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL138302253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care