MEDICARE: AGES GROUP 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	RN291271	OH

General Provider Information

NPI Number	:	1881911642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGES GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 361884
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43236-1884
Country	:	US
Telephone Number	:	740-973-5131
Fax Number	:	614-948-1140

Provider Business Practice Location Address
First Line	:	5554 ALBANY SPRINGS DR
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-7001
Country	:	US
Telephone Number	:	740-973-5131
Fax Number	:	614-948-1140

Authorized Official
Title or Position	:	OWNER
Name	:	MISS MARY THOMAS
Credential	:	RN
Telephone Number	:	614-948-1140

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	05/03/2010

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