Provider Demographics
NPI:1033157045
Name:TRIPLE AGI INC
Entity Type:Organization
Organization Name:TRIPLE AGI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, DON/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNADINE
Authorized Official - Middle Name:ADANNA
Authorized Official - Last Name:UDEOZOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-522-5758
Mailing Address - Street 1:1106 N HWY 360 STE 410
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2594
Mailing Address - Country:US
Mailing Address - Phone:972-522-5758
Mailing Address - Fax:972-522-5922
Practice Address - Street 1:1106 N HWY 360 SUITE 410
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2594
Practice Address - Country:US
Practice Address - Phone:972-522-5758
Practice Address - Fax:972-522-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010392251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health