NPIMap

Organization Active NPI

Aging Well Health Care, LLC

  • Home Health Agency
  • Saint Louis, MO
National Provider Identifier
1215936588
Registry record updated Sep 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
755 Issued in MO
Legal business name
AGING WELL HEALTH CARE, LLC
Practice address
7212 Balson Ave
Saint Louis, MO 63130-3001
Phone
(314) 726-5600
Fax
(314) 754-9317
NPI assigned
Jul 19, 2005
Last updated
Sep 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2010

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

Authorized official

Name
Irina BursakNPI 1609458330
Title
Administrator
Phone
(314) 726-5600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 755 MO Primary
Home Health Agency 251E00000X 1010588 IL
Nursing Care Agency 251J00000X 265855403 MO
Adult Day Care Clinic/Center 261QA0600X 609 MO
Physical Therapy Clinic/Center 261QP2000X 266633 MO
Occupational Medicine Clinic/Center 261QX0100X 266633 MO
Respite Care 385H00000X 285855409 MO

Addresses

Primary practice location

7212 Balson Ave
Saint Louis, MO 63130-3001

Mailing address

7212 Balson Ave
Saint Louis, MO 63130-3001
Phone (314) 726-5600

Other identifiers 5

IdentifierTypeStateIssuer
585855406MedicaidMO
285855409MedicaidMO
265855403MedicaidMO
295855407MedicaidMO
575855408MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040113000542 MO Part A Provider - Home Health Agency 1153232038 Practice locations: Maryville, IL; O Fallon, MO; Saint Louis, MO
O20210903001172 MO Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 1153232038 Practice locations: Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215936588. Details of each certification follow.

Home health agency certification: CCN 267585

Legal name
AGING WELL HEALTH CARE, LLC
Doing business as
AW HEALTH CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 21, 2004
Last certification
Aug 11, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Feb 8, 2002 in MO
Enrollment address
7212 Balson Ave
Saint Louis, MO 63130-3001

Care Compare: Home health agency

Medicare Care Compare
Listed as
Aw Health CareCCN 267585 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Jun 21, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

5 Schiber Ct
Ste E
Maryville, IL 62062
Phone (618) 344-8800

2000 Boardwalk Place Dr
O Fallon, MO 63368
Phone (303) 829-5758

5000 Cedar Plaza Pkwy
Ste 250
Saint Louis, MO 63128
Phone (314) 842-9700

7216 Balson Ave
Saint Louis, MO 63130
Phone (314) 726-5600

7212 Balson Ave
University Cy, MO 63130
Phone (314) 726-5600

24 W Main St
#218
Wentzville, MO 63385
Phone (314) 932-1472

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Irina Bursak Individual 5% Or Greater Direct Ownership InterestAdministrator Feb 8, 2002 33.3%
General Partnership Interest Jan 14, 2002
Corporate OfficerPresident Feb 8, 2002
W-2 Managing EmployeeAdministrator Feb 8, 2002
Julia Escandon Rozin Individual 5% Or Greater Direct Ownership InterestClinical Director Feb 8, 2002 33.3%
General Partnership Interest Jan 14, 2009
Corporate OfficerChief Excecutive Officer Feb 8, 2002
W-2 Managing EmployeeClinical Director Feb 8, 2002
Susan Bursak Individual 5% Or Greater Direct Ownership InterestBusiness Manager Feb 8, 2002 33.3%
General Partnership Interest Jan 14, 2009
Corporate OfficerFinancial Officer Feb 8, 2002
W-2 Managing EmployeeBusiness Manager Feb 8, 2002

Practitioners & affiliated clinicians

Practitioners 238

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.

View all 238

Affiliated clinicians 79

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 79

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284940800000",
    "number": "1215936588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7212 BALSON AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631303001",
            "telephone_number": "314-726-5600",
            "fax_number": "314-754-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7212 BALSON AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631303001",
            "telephone_number": "314-726-5600",
            "fax_number": "314-754-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGING WELL HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2010-09-20",
        "status": "A",
        "authorized_official_last_name": "BURSAK",
        "authorized_official_first_name": "IRINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "314-726-5600"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MO",
            "license": "755",
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1010588",
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "MO",
            "license": "265855403",
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "MO",
            "license": "609",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MO",
            "license": "266633",
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "MO",
            "license": "266633",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "MO",
            "license": "285855409",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "585855406",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "285855409",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265855403",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "295855407",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "575855408",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.