Provider Demographics
NPI:1114682275
Name:AGMB HEALTHCARE
Entity Type:Organization
Organization Name:AGMB HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-444-6319
Mailing Address - Street 1:107 COMMONS DR STE A
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9262
Mailing Address - Country:US
Mailing Address - Phone:980-444-6319
Mailing Address - Fax:
Practice Address - Street 1:107 COMMONS DR STE A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9262
Practice Address - Country:US
Practice Address - Phone:980-444-6319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGMB HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care