Provider Demographics
NPI:1952614067
Name:AGELESS LIVING HOME HEALTH LLC
Entity Type:Organization
Organization Name:AGELESS LIVING HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-582-5840
Mailing Address - Street 1:431 WOLFE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4630
Mailing Address - Country:US
Mailing Address - Phone:210-582-5840
Mailing Address - Fax:210-582-5841
Practice Address - Street 1:431 WOLFE RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4630
Practice Address - Country:US
Practice Address - Phone:210-582-5840
Practice Address - Fax:210-582-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018034OtherTEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES
TX220078401Medicaid
TX014016OtherTEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES
TX220078402Medicaid