Provider Demographics
NPI:1609569383
Name:AGELESS ESSENTIALS LLC
Entity Type:Organization
Organization Name:AGELESS ESSENTIALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-630-2455
Mailing Address - Street 1:31911 COUNTY ROAD EE
Mailing Address - Street 2:
Mailing Address - City:WRAY
Mailing Address - State:CO
Mailing Address - Zip Code:80758
Mailing Address - Country:US
Mailing Address - Phone:970-630-2455
Mailing Address - Fax:
Practice Address - Street 1:31911 COUNTY ROAD EE
Practice Address - Street 2:
Practice Address - City:WRAY
Practice Address - State:CO
Practice Address - Zip Code:80758
Practice Address - Country:US
Practice Address - Phone:970-630-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20181386166OtherPRIVATE DUTY HOME CARE