Provider Demographics
NPI:1023769312
Name:AGE WELL HEALTH SOLUTIONS L.L.C.
Entity type:Organization
Organization Name:AGE WELL HEALTH SOLUTIONS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:RUDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-330-5707
Mailing Address - Street 1:910 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1627
Mailing Address - Country:US
Mailing Address - Phone:314-330-5707
Mailing Address - Fax:
Practice Address - Street 1:134 ENCHANTED PKWY STE 104
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-5495
Practice Address - Country:US
Practice Address - Phone:314-227-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service