Provider Demographics
NPI:1255204939
Name:AGEWISE TRANSPORTATION LLC
Entity type:Organization
Organization Name:AGEWISE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-352-2709
Mailing Address - Street 1:2302 SAGE DR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2277
Mailing Address - Country:US
Mailing Address - Phone:202-352-2709
Mailing Address - Fax:
Practice Address - Street 1:2302 SAGE DR
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2277
Practice Address - Country:US
Practice Address - Phone:202-352-2709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)