Healthcare Provider Details

I. General information

NPI: 1790476067
Provider Name (Legal Business Name): AGING AT HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLIVE ST APT 405
SAINT LOUIS MO
63101-1451
US

IV. Provider business mailing address

915 OLIVE ST APT 405
SAINT LOUIS MO
63101-1451
US

V. Phone/Fax

Practice location:
  • Phone: 314-337-8600
  • Fax: 314-390-9658
Mailing address:
  • Phone: 314-337-8600
  • Fax: 314-390-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. RHONDA ANNE JOHNSTON
Title or Position: ADMINISTRATOR
Credential: MA
Phone: 314-761-3800