MEDICARE: AGELESS HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1306302435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGELESS HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	6475 NEW HAMPSHIRE AVE STE 604
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3280
Country	:	US
Telephone Number	:	301-679-9653
Fax Number	:	240-494-2603

Provider Business Practice Location Address
First Line	:	6475 NEW HAMPSHIRE AVE STE 604
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3280
Country	:	US
Telephone Number	:	240-481-7844
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CARLENE GAYLE GAYLE BANKS
Credential	:
Telephone Number	:	240-481-7844

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	05/22/2026

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