Provider Demographics
NPI:1407154164
Name:AGELESS PLACEMENTS EAST INC
Entity Type:Organization
Organization Name:AGELESS PLACEMENTS EAST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIERDRE
Authorized Official - Middle Name:JANINE
Authorized Official - Last Name:JOHNCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-662-2562
Mailing Address - Street 1:710 OAKFIELD DR STE 135
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4931
Mailing Address - Country:US
Mailing Address - Phone:813-662-2562
Mailing Address - Fax:813-655-2625
Practice Address - Street 1:710 OAKFIELD DR STE 135
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4931
Practice Address - Country:US
Practice Address - Phone:813-662-2562
Practice Address - Fax:813-655-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X, 253Z00000X
FL30211523251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003913100Medicaid