Healthcare Provider Details

I. General information

NPI: 1538285408
Provider Name (Legal Business Name): AGING AHEAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/08/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 MANCHESTER ROAD
MANCHESTER MO
63011
US

IV. Provider business mailing address

14535 MANCHESTER ROAD
MANCHESTER MO
63011
US

V. Phone/Fax

Practice location:
  • Phone: 636-207-0847
  • Fax: 636-207-1329
Mailing address:
  • Phone: 636-207-0847
  • Fax: 636-207-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: LISA M KNOLL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 636-207-0847