Provider Demographics
NPI:1144595596
Name:AGNES ELDERLY CARE SITTER SERVICES AGENCY
Entity Type:Organization
Organization Name:AGNES ELDERLY CARE SITTER SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-504-2380
Mailing Address - Street 1:3517 BROCKDALE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-8991
Mailing Address - Country:US
Mailing Address - Phone:706-922-7993
Mailing Address - Fax:
Practice Address - Street 1:3517 BROCKDALE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-8991
Practice Address - Country:US
Practice Address - Phone:706-922-7993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCB20120000162253Z00000X
SC17665253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care