Provider Demographics
NPI:1003607730
Name:AGEWELL CONNECTIONS LLC.
Entity type:Organization
Organization Name:AGEWELL CONNECTIONS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-403-6191
Mailing Address - Street 1:255 B ST STE 308
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3517
Mailing Address - Country:US
Mailing Address - Phone:208-244-0040
Mailing Address - Fax:208-277-1881
Practice Address - Street 1:255 B ST STE 308
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3517
Practice Address - Country:US
Practice Address - Phone:208-244-0040
Practice Address - Fax:208-244-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347B00000XTransportation ServicesBus
No253Z00000XAgenciesIn Home Supportive Care
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment