Provider Demographics
NPI:1588347694
Name:AGELESS INDEPENDENCE LLC
Entity type:Organization
Organization Name:AGELESS INDEPENDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOWINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:606-515-7741
Mailing Address - Street 1:137 DIXON DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-7407
Mailing Address - Country:US
Mailing Address - Phone:606-515-7741
Mailing Address - Fax:
Practice Address - Street 1:137 DIXON DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-7407
Practice Address - Country:US
Practice Address - Phone:606-515-7741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care