Provider Demographics
NPI:1104425560
Name:AGING WHOLEHEARTEDLY LLC
Entity type:Organization
Organization Name:AGING WHOLEHEARTEDLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:IMPERATORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-572-9737
Mailing Address - Street 1:1375 GATEWAY BLVD STE 37
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8304
Mailing Address - Country:US
Mailing Address - Phone:561-572-9737
Mailing Address - Fax:
Practice Address - Street 1:1375 GATEWAY BLVD STE 37
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8304
Practice Address - Country:US
Practice Address - Phone:561-572-9737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care