Provider Demographics
NPI:1457505992
Name:AGGIE HOME CARE, INC.
Entity Type:Organization
Organization Name:AGGIE HOME CARE, INC.
Other - Org Name:AGGIE HOME CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHRADER
Authorized Official - Suffix:SR
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:724-569-1889
Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478-8943
Mailing Address - Country:US
Mailing Address - Phone:724-569-1889
Mailing Address - Fax:724-569-1899
Practice Address - Street 1:25 MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-8943
Practice Address - Country:US
Practice Address - Phone:724-569-1889
Practice Address - Fax:724-569-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021374380001Medicare Oscar/Certification