Provider Demographics
NPI:1003440140
Name:ST.AGATHA HOME HEALTH LLC
Entity Type:Organization
Organization Name:ST.AGATHA HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:T
Authorized Official - Last Name:ESGUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-248-7450
Mailing Address - Street 1:11145 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4384
Mailing Address - Country:US
Mailing Address - Phone:630-248-7450
Mailing Address - Fax:702-473-9003
Practice Address - Street 1:11145 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4384
Practice Address - Country:US
Practice Address - Phone:702-473-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health