Organization
AGEWELL RPM
Active
Other names
AGEWELL RPM
Organization subpart
No
Provider details
NPI number
Authorized official
LUKE A KIST (OWNER)
(251) 223-2212
Entity
Organization
Contact information
Practice address
82 GRISWOLD DR, WEST HARTFORD, CT 06119-1146
(251) 223-2212
Mailing address
82 GRISWOLD DR, WEST HARTFORD, CT 06119-1146
(251) 223-2212
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
03/31/2025
Last updated
03/31/2025
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