MEDICARE: AGE WELL ALLIANCE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	376J00000X	Homemaker
3	253Z00000X	In Home Supportive Care Agency
4	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1912710781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGE WELL ALLIANCE

Provider Business Mailing Address
First Line	:	82 GRISWOLD DR
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1146
Country	:	US
Telephone Number	:	251-223-2212
Fax Number	:

Provider Business Practice Location Address
First Line	:	82 GRISWOLD DR
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1146
Country	:	US
Telephone Number	:	251-223-2212
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LUKE A KIST
Credential	:
Telephone Number	:	251-223-2212

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	04/10/2025

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Directions to “AGE WELL ALLIANCE ” Practice Location

Language	Start Address	Practice Location

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