Healthcare Provider Details

I. General information

NPI: 1629256029
Provider Name (Legal Business Name): AGELESS CARE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 7TH ST SW
ROSEAU MN
56751-1498
US

IV. Provider business mailing address

702 7TH ST SW
ROSEAU MN
56751-1498
US

V. Phone/Fax

Practice location:
  • Phone: 218-463-3695
  • Fax: 218-463-3708
Mailing address:
  • Phone: 218-463-3695
  • Fax: 218-463-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number337643
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number337643
License Number StateMN

VIII. Authorized Official

Name: KARIN MARIE LOVEN-KOTZ
Title or Position: CEO
Credential:
Phone: 218-463-3695