Provider Demographics
NPI:1184470809
Name:AGING WELL HEALTH CARE, LLC
Entity type:Organization
Organization Name:AGING WELL HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-726-5600
Mailing Address - Street 1:7212 BALSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3001
Mailing Address - Country:US
Mailing Address - Phone:314-726-5600
Mailing Address - Fax:314-754-9317
Practice Address - Street 1:7212 BALSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-3001
Practice Address - Country:US
Practice Address - Phone:314-726-5600
Practice Address - Fax:314-754-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy