=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538285408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGING AHEAD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 11/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14535 MANCHESTER ROAD
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-207-0847
-----------------------------------------------------
Fax | 636-207-1329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14535 MANCHESTER ROAD
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-207-0847
-----------------------------------------------------
Fax | 636-207-1329
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | LISA M KNOLL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-207-0847
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 174200000X
-----------------------------------------------------
Taxonomy Name | Meals Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------