Provider Demographics
NPI:1740571512
Name:AGEWELL HOME CARE LLC
Entity Type:Organization
Organization Name:AGEWELL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-345-8770
Mailing Address - Street 1:4940 VIKING DR STE 545
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5327
Mailing Address - Country:US
Mailing Address - Phone:952-345-8770
Mailing Address - Fax:952-345-1101
Practice Address - Street 1:4940 VIKING DR STE 545
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5327
Practice Address - Country:US
Practice Address - Phone:952-345-8770
Practice Address - Fax:952-345-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN346396251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health