Organization
AGEGRACE, INC.
Active
Other names
JAO Companies
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER OWENS QDDS (CEO/ADMINISTRATOR)
(612) 707-8121
Entity
Organization
Contact information
Practice address
635 PHALEN BLVD APT 401, SAINT PAUL, MN 55130-5308
(612) 707-8121
Mailing address
PO BOX 28041, OAKDALE, MN 55128-0041
(612) 707-8121
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M52298200
—
MN
Enumeration date
04/14/2020
Last updated
11/05/2020
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