Provider Demographics
NPI:1134477672
Name:AGING MADE EASY, LLC
Entity Type:Organization
Organization Name:AGING MADE EASY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-265-6004
Mailing Address - Street 1:205 STATE ROUTE B STE 8
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-2000
Mailing Address - Country:US
Mailing Address - Phone:573-265-6004
Mailing Address - Fax:573-265-1261
Practice Address - Street 1:205 STATE ROUTE B STE 8
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-2000
Practice Address - Country:US
Practice Address - Phone:573-265-6004
Practice Address - Fax:573-265-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========Medicaid