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General NPI Number Information
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NPI Number | 1447154372
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Entity Type | Organization
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Legal Business Name | AGELESS LIVING, LLC
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 4613 N 75TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53218-4719
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Country | US
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Telephone | 414-381-2927
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Fax |
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Provider Business Mailing Address
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Address Line | 23144 CINCO RANCH BLVD STE B1143
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City | KATY
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State | TX
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Zip | 77494-2894
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Country | US
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Telephone | 414-381-2937
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | NEQUILIA EARNEST
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Credential |
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Telephone | 414-381-2937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NULL
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | NULL
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