MEDICARE: AGE OF ENDLESS POSSIBILITIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1932799061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGE OF ENDLESS POSSIBILITIES

Provider Business Mailing Address
First Line	:	437 W BUTLER RD
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2532
Country	:	US
Telephone Number	:	864-520-2262
Fax Number	:

Provider Business Practice Location Address
First Line	:	437 W BUTLER RD
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2532
Country	:	US
Telephone Number	:	864-520-2262
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENDRA MCKINNEY
Credential	:
Telephone Number	:	864-367-3808

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	01/22/2021

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