Healthcare Provider Details

I. General information

NPI: 1003607730
Provider Name (Legal Business Name): AGEWELL CONNECTIONS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 B ST STE 308
IDAHO FALLS ID
83402-3517
US

IV. Provider business mailing address

255 B ST STE 308
IDAHO FALLS ID
83402-3517
US

V. Phone/Fax

Practice location:
  • Phone: 208-244-0040
  • Fax: 208-244-0040
Mailing address:
  • Phone: 208-244-0040
  • Fax: 208-277-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JAMES JOHNSON
Title or Position: FOUNDER
Credential:
Phone: 208-403-6191