Provider Demographics
NPI:1326236373
Name:AGILE HOME HEALTH CARE, INC
Entity Type:Organization
Organization Name:AGILE HOME HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANCHETA
Authorized Official - Last Name:GASSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:773-744-5365
Mailing Address - Street 1:5875 N LINCOLN AVE
Mailing Address - Street 2:SUITE 126
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4672
Mailing Address - Country:US
Mailing Address - Phone:773-506-7450
Mailing Address - Fax:773-506-7460
Practice Address - Street 1:5875 N LINCOLN AVE
Practice Address - Street 2:SUITE 126
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4672
Practice Address - Country:US
Practice Address - Phone:773-506-7450
Practice Address - Fax:773-506-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010782251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health