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General NPI Number Information
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NPI Number | 1003607730
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Entity Type | Organization
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Legal Business Name | AGEWELL CONNECTIONS LLC.
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 255 B ST STE 308
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3517
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Country | US
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Telephone | 208-244-0040
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Fax | 208-244-0040
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Provider Business Mailing Address
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Address Line | 255 B ST STE 308
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3517
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Country | US
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Telephone | 208-244-0040
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Fax | 208-277-1881
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Authorized Official
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Title or Position | FOUNDER
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Name | ROBERT JAMES JOHNSON
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Credential |
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Telephone | 208-403-6191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347B00000X
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Taxonomy Name | Bus
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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