Provider Demographics
NPI:1184801995
Name:AGELESS PLACEMENTS WEST, INC.
Entity type:Organization
Organization Name:AGELESS PLACEMENTS WEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-710-2124
Mailing Address - Street 1:10740 EVENINGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5027
Mailing Address - Country:US
Mailing Address - Phone:727-710-2124
Mailing Address - Fax:727-845-8425
Practice Address - Street 1:10740 EVENINGWOOD CT
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5027
Practice Address - Country:US
Practice Address - Phone:727-710-2124
Practice Address - Fax:727-845-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230216251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health