Agegrace, Inc.

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

AGEGRACE, INC.

Practice address

635 Phalen Blvd Apt 401
Saint Paul, MN 55130-5308

Phone

(612) 707-8121

NPI assigned

Apr 14, 2020

Organization subpart

No

Name

Jennifer Owens, QDDSNPI 1154922011

Title

Ceo/Administrator

Phone

(612) 707-8121

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Owens, QDDS

  • Case Manager/Care Coordinator
  • Saint Paul, MN
  • NPI 1154922011
  NPD Authorized official

• JAO Companies Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 5, 2020.

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604534400000",
    "number": "1033738554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28041",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551280041",
            "telephone_number": "612-707-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 PHALEN BLVD APT 401",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551305308",
            "telephone_number": "612-707-8121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGEGRACE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "612-707-8121",
        "authorized_official_credential": "QDDS"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M52298200",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Unknown",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "635 Phalen Blvd Apt 401",
            "city": "Saint Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551305308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "JAO Companies",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Saint Paul, MN
• Health Maintenance Organization in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.