Provider Demographics
NPI:1083172985
Name:AGILITY ADVANTAGE HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:AGILITY ADVANTAGE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIMITRA
Authorized Official - Middle Name:TUMBA
Authorized Official - Last Name:KAULU
Authorized Official - Suffix:
Authorized Official - Credentials:LRT, CRT
Authorized Official - Phone:612-212-9212
Mailing Address - Street 1:10339 QUAIL CIR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-5418
Mailing Address - Country:US
Mailing Address - Phone:612-212-9212
Mailing Address - Fax:
Practice Address - Street 1:10339 QUAIL CIR N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-5418
Practice Address - Country:US
Practice Address - Phone:612-212-9212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332U00000XSuppliersHome Delivered Meals