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

Last updated

Nov 5, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Owens, QDDSNPI 1154922011

Title

Ceo/Administrator

Phone

(612) 707-8121

Specialties & licenses 5

Addresses

Other names 1

• JAO Companies Other name

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Owens, QDDS

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

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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": [],
    "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"
        }
    ]
}

• African American Survivor Services
• Afrocare, LLC
• Afton Road Dental Assoc
• Agape Restore Restyle and Clean,Inc (Agape Services)
• Nitin Agarwal, M.B.B.S
• Ritu Aggarwal, BDS
• Peter David Aggen, DPT
• Agha LLC (Agha Care)
• Agrata Home Care Services, Inc.
• Laurie Bonita Agrimson, FNP-BC

• Health Maintenance Organization in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• 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.