Provider Demographics
NPI:1417195702
Name:AEGIS HEALTHCARE HOLDINGS, INC
Entity Type:Organization
Organization Name:AEGIS HEALTHCARE HOLDINGS, INC
Other - Org Name:AEGIS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IFEDIRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-499-4966
Mailing Address - Street 1:1655 FORT MYER DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3113
Mailing Address - Country:US
Mailing Address - Phone:410-499-4966
Mailing Address - Fax:
Practice Address - Street 1:1705 CINNAMON TEAL WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-4003
Practice Address - Country:US
Practice Address - Phone:410-499-4966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child