Provider Demographics
NPI:1457511974
Name:AGELESS HOME HEALTH CARE, LLC.
Entity Type:Organization
Organization Name:AGELESS HOME HEALTH CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS
Authorized Official - Phone:718-646-3777
Mailing Address - Street 1:1809 GRAVESEND NECK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4510
Mailing Address - Country:US
Mailing Address - Phone:718-646-3777
Mailing Address - Fax:718-646-3444
Practice Address - Street 1:1809 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4510
Practice Address - Country:US
Practice Address - Phone:718-646-3777
Practice Address - Fax:718-646-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health