# AGELESS PRIVATE HOME HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295054278
- **Authorized official:** JACQUELINE PEAN REGISTERED NURSE (OWNER)
- **Authorized official phone:** (404) 553-6671

## Contact information

- **Practice address:** 3188 KRISAM CREEK DR, LOGANVILLE, GA 30052-7907
- **Practice address phone:** (404) 553-6671
- **Mailing address:** 3188 KRISAM CREEK DR, LOGANVILLE, GA 30052-7907
- **Mailing address phone:** (404) 553-6671

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 067-R-0498 | GA | Yes |

## Other

- **Enumeration date:** 05/30/2010
- **Last updated:** 05/30/2010