Provider Demographics
NPI:1013640259
Name:AGLOW HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:AGLOW HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:KOU
Authorized Official - Last Name:GEHYIGON-WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:763-913-8125
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-0152
Mailing Address - Country:US
Mailing Address - Phone:763-913-8125
Mailing Address - Fax:
Practice Address - Street 1:6626 RED BIRCH CT
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1337
Practice Address - Country:US
Practice Address - Phone:763-913-8125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care