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General NPI Number Information
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NPI Number | 1215936588
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Entity Type | Organization
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Legal Business Name | AGING WELL HEALTH CARE, LLC
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 7212 BALSON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63130-3001
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Country | US
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Telephone | 314-726-5600
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Fax | 314-754-9317
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Provider Business Mailing Address
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Address Line | 7212 BALSON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63130-3001
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Country | US
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Telephone | 314-726-5600
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Fax | 314-754-9317
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | IRINA BURSAK
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Credential |
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Telephone | 314-726-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 609
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 266633
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1010588
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 265855403
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 285855409
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License Number State | MO
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Taxonomy #6
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 266633
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License Number State | MO
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Taxonomy #7
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 755
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License Number State | MO
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