Healthcare Provider Details

I. General information

NPI: 1184801995
Provider Name (Legal Business Name): AGELESS PLACEMENTS WEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10740 EVENINGWOOD CT
TRINITY FL
34655-5027
US

IV. Provider business mailing address

10740 EVENINGWOOD CT
TRINITY FL
34655-5027
US

V. Phone/Fax

Practice location:
  • Phone: 727-710-2124
  • Fax: 727-845-8425
Mailing address:
  • Phone: 727-710-2124
  • Fax: 727-845-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number230216
License Number StateFL

VIII. Authorized Official

Name: MRS. SAMANTHA VICTORIA WEST
Title or Position: PRESIDENT
Credential:
Phone: 727-710-2124