Healthcare Provider Details

I. General information

NPI: 1447154372
Provider Name (Legal Business Name): AGELESS LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4613 N 75TH ST
MILWAUKEE WI
53218-4719
US

IV. Provider business mailing address

23144 CINCO RANCH BLVD STE B1143
KATY TX
77494-2894
US

V. Phone/Fax

Practice location:
  • Phone: 414-381-2927
  • Fax:
Mailing address:
  • Phone: 414-381-2937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: NEQUILIA EARNEST
Title or Position: CEO/PRESIDENT
Credential:
Phone: 414-381-2937