1639427214 NPI number — AGILE IN-HOME CARE, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639427214 NPI number — AGILE IN-HOME CARE, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGILE IN-HOME CARE, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639427214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2804 ROSE ACRES LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYLAND HEIGHTS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63043-1180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-443-7565
Provider Business Mailing Address Fax Number:
314-298-3886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 BROOKES DRIVE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
HAZELWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-443-7565
Provider Business Practice Location Address Fax Number:
314-298-3886
Provider Enumeration Date:
08/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
BROOKE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
816-805-3974

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  LC1153679 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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