Provider Demographics
NPI:1306302435
Name:AGELESS HEALTHCARE LLC
Entity type:Organization
Organization Name:AGELESS HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:GAYLE BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-481-7844
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-0428
Mailing Address - Country:US
Mailing Address - Phone:301-679-9653
Mailing Address - Fax:240-494-2603
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE STE 604
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3280
Practice Address - Country:US
Practice Address - Phone:240-481-7844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, PediatricGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty