Provider Demographics
NPI:1891077624
Name:AGE WELL SENIOR SERVICES, INC
Entity Type:Organization
Organization Name:AGE WELL SENIOR SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DITTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-855-8033
Mailing Address - Street 1:24300 EL TORO RD
Mailing Address - Street 2:BLDG. A, SUITE 2000
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-2737
Mailing Address - Country:US
Mailing Address - Phone:949-855-8033
Mailing Address - Fax:949-855-8025
Practice Address - Street 1:24300 EL TORO RD
Practice Address - Street 2:BLDG. A, SUITE 2000
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2737
Practice Address - Country:US
Practice Address - Phone:949-855-8033
Practice Address - Fax:949-855-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
CACA161788343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)