Aging Well Health Care, LLC
Organization Active NPI Home Health Agency · Saint Louis, MO
NPI 1215936588 · NPPES record last updated Sep 20, 2010
Key facts
- NPI
- 1215936588
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 755 (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
- Organization subpart
- No
Authorized official
- Name
- Irina Bursak
- Title
- Administrator
- Phone
- (314) 726-5600
Practitioners 237
-
Michael J Adams, DO
-
Monakka Afroz, MD
-
Zaheer Ahmed, M.D.
-
Lizette Alvarez, M.D.
-
Nicole E Baker, DO
-
Leigh Rose Ball, MD
-
Alissa Ballard, DO
-
Byron Dominic Baptist, M.D.
-
Joshua Michael Bell, PA-C
-
Chantal Gabrielle Berez, M.D.
-
Anthony J Berni, M.D.
-
Saqib Bhutto, M.D.
-
Joshua David Binek, M.D.
-
William D Birenbaum, M.D.
-
Neil Alan Bobenhouse, DO, MHA
-
Jeffrey L. Boesch, M.D.
-
William G Bowen, MD
-
Matthew Breeden, MD
-
Stacy R Broussard, M.D.
Affiliated clinicians 79
-
Michael J Adams, DO
-
Roland Akinyede, M.D.
-
Alissa Ballard, DO
-
Yolanda Bledsoe, MD
-
Shawn K Brunk, DO
-
Bryan Patrick Burns, D.O.
-
Marie E. Campagna, M.D.
-
Jon Brandon Carlson, M.D.
-
Navin Choudhary, MD
-
Cathy M Coleman, ANP
-
Christopher Brian Espana, M.D.
-
Erin Rice Fick, D.O.
-
Joseph Michael Fritz, M.D.
-
Andrew S Gold, M.D.
-
Gary D Gray, MD
Medicare Care Compare: Home health agency
- Listed as
- Aw Health Care
- Overall star rating
- ★★★★★ 4.5 of 5
- Ownership
- Proprietary
- Certified
- Jun 21, 2004
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
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
- LLC · Proprietary
- Incorporated
- Feb 8, 2002 in MO
- Enrollment address
- 7212 Balson Ave
Saint Louis, MO 63130-3001
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Irina Bursak |
5% Or Greater Direct Ownership Interest |
Feb 8, 2002 | 33.3% |
| General Partnership Interest | Jan 14, 2002 | ||
| Corporate Officer |
Feb 8, 2002 | ||
| W-2 Managing Employee |
Feb 8, 2002 | ||
| Julia Escandon Rozin |
5% Or Greater Direct Ownership Interest |
Feb 8, 2002 | 33.3% |
| General Partnership Interest | Jan 14, 2009 | ||
| Corporate Officer |
Feb 8, 2002 | ||
| W-2 Managing Employee |
Feb 8, 2002 | ||
| Susan Bursak |
5% Or Greater Direct Ownership Interest |
Feb 8, 2002 | 33.3% |
| General Partnership Interest | Jan 14, 2009 | ||
| Corporate Officer |
Feb 8, 2002 | ||
| W-2 Managing Employee |
Feb 8, 2002 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
5 Schiber Ct
Ste E
Maryville, IL 62062
Phone (618) 344-8800
24 W Main St
#218
Wentzville, MO 63385
Phone (314) 932-1472
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 755 | MO | Yes |
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 295855407 | Medicaid | MO | |
| 575855408 | Medicaid | MO | |
| 585855406 | Medicaid | MO | |
| 285855409 | Medicaid | MO | |
| 265855403 | Medicaid | MO |
Other providers in Saint Louis, MO
- Agility Orthopaedics, LLC
- Aging at Home Inc.
- Aging in Your Place
- Aging in Your Place LLC
- Aging Well Health Care, LLC
- Shannon Christine Agner
- Trana Agnew
- Sarah Agoncillo
- Laura Elizabeth Agostini
- Dondra Marie Agovino
All providers in Saint Louis, MO · Home Health Agency in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.