Provider Demographics
NPI:1215087267
Name:AGELESS HEALTH, LLC
Entity type:Organization
Organization Name:AGELESS HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HELISE
Authorized Official - Middle Name:BEVERLY
Authorized Official - Last Name:BICHEFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:610-436-1584
Mailing Address - Street 1:32 RAFFAELA DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2559
Mailing Address - Country:US
Mailing Address - Phone:610-436-1584
Mailing Address - Fax:610-436-9057
Practice Address - Street 1:600 E MARSHALL ST
Practice Address - Street 2:SUITE 303
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4441
Practice Address - Country:US
Practice Address - Phone:610-436-1584
Practice Address - Fax:610-436-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008887L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110233030OtherRAIL ROAD MEDICARE
PA2222550001OtherKEYSTONE HPE
PA0017243190003Medicaid
PA110233030OtherRAIL ROAD MEDICARE
PA2222550001OtherKEYSTONE HPE