Provider Demographics
NPI:1497979868
Name:AGE CARE LLC
Entity Type:Organization
Organization Name:AGE CARE LLC
Other - Org Name:FOX RIDGE ESTATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-968-8279
Mailing Address - Street 1:P.O. BOX 665
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018
Mailing Address - Country:US
Mailing Address - Phone:479-968-8279
Mailing Address - Fax:479-968-4331
Practice Address - Street 1:4216 FOX RIDGE DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72022-8308
Practice Address - Country:US
Practice Address - Phone:479-968-8279
Practice Address - Fax:479-968-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility