NPIMap

Organization Active NPI

Ageless Private Home Healthcare

  • Home Health Agency
  • Loganville, GA
National Provider Identifier
1295054278
Registry record updated May 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
067-R-0498 Issued in GA
Legal business name
AGELESS PRIVATE HOME HEALTHCARE
Practice address
3188 Krisam Creek Dr
Loganville, GA 30052-7907
Phone
(404) 553-6671
NPI assigned
May 30, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2010

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

Authorized official

Name
Jacqueline Pean, REGISTERED NURSENPI 1134431596
Title
Owner
Phone
(404) 553-6671

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 067-R-0498 GA Primary

Addresses

Primary practice location

3188 Krisam Creek Dr
Loganville, GA 30052-7907

Mailing address

3188 Krisam Creek Dr
Loganville, GA 30052-7907
Phone (404) 553-6671

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1275177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275177600000",
    "number": "1295054278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3188 KRISAM CREEK DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300527907",
            "telephone_number": "404-553-6671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3188 KRISAM CREEK DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300527907",
            "telephone_number": "404-553-6671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGELESS PRIVATE HOME HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-30",
        "last_updated": "2010-05-30",
        "status": "A",
        "authorized_official_last_name": "PEAN",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-553-6671",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "067-R-0498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loganville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2010; 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.