Healthcare Provider Details

I. General information

NPI: 1609222041
Provider Name (Legal Business Name): AGEOPTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 LAKE STREET SUITE 300
OAK PARK IL
60301-1102
US

IV. Provider business mailing address

1048 LAKE STREET SUITE 300
OAK PARK IL
60301-1102
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-0258
  • Fax:
Mailing address:
  • Phone: 708-383-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN LAVIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 708-383-0258