Provider Demographics
NPI:1174009690
Name:BLUE AGAVE SOLUTIONS
Entity Type:Organization
Organization Name:BLUE AGAVE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-568-6800
Mailing Address - Street 1:10109 LAKE CREEK PKWY UNIT 170434
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-0119
Mailing Address - Country:US
Mailing Address - Phone:972-849-4000
Mailing Address - Fax:
Practice Address - Street 1:15825 CARLTON OAKS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-2162
Practice Address - Country:US
Practice Address - Phone:972-849-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty