Provider Demographics
NPI:1215748827
Name:AGELESS LIFE SERVICES LLC
Entity type:Organization
Organization Name:AGELESS LIFE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-360-9750
Mailing Address - Street 1:2917 TODD DR APT 3
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2972
Mailing Address - Country:US
Mailing Address - Phone:319-360-9750
Mailing Address - Fax:
Practice Address - Street 1:2917 TODD DR APT 3
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2972
Practice Address - Country:US
Practice Address - Phone:319-360-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health