Provider Demographics
NPI:1285223776
Name:AGILE CARE COORDINATION
Entity Type:Organization
Organization Name:AGILE CARE COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOSHA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-570-1734
Mailing Address - Street 1:121 PETTIS RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3404
Mailing Address - Country:US
Mailing Address - Phone:907-570-1734
Mailing Address - Fax:
Practice Address - Street 1:121 PETTIS RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3404
Practice Address - Country:US
Practice Address - Phone:907-570-1734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management