Provider Demographics
NPI:1275899262
Name:AGILE HOME HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:AGILE HOME HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUKAMUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-338-2325
Mailing Address - Street 1:10103 FONDREN RD
Mailing Address - Street 2:STE #440
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096
Mailing Address - Country:US
Mailing Address - Phone:713-338-2325
Mailing Address - Fax:713-338-2328
Practice Address - Street 1:10103 FONDREN RD
Practice Address - Street 2:STE #440
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096
Practice Address - Country:US
Practice Address - Phone:713-338-2325
Practice Address - Fax:713-338-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
TX0148813747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367002801Medicaid