Healthcare Provider Details

I. General information

NPI: 1770473886
Provider Name (Legal Business Name): AGEWELL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5676 RAMMELL RD STE C
IDAHO FALLS ID
83401-1041
US

IV. Provider business mailing address

5676 RAMMELL RD STE C
IDAHO FALLS ID
83401-1041
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

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