MEDICARE: AGING MADE EASY, 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	LC0796509	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912195736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGING MADE EASY, LLC

Provider Business Mailing Address
First Line	:	28 KATHRYN DR
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-1813
Country	:	US
Telephone Number	:	573-265-6004
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 KATHRYN DR
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-1813
Country	:	US
Telephone Number	:	573-265-6004
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	SANDRA KAY JOHNSON
Credential	:
Telephone Number	:	573-263-1487

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/05/2007

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