Provider Demographics
NPI:1508161662
Name:AGILE HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:AGILE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES-PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-424-2041
Mailing Address - Street 1:216 CRAIN HWY N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3079
Mailing Address - Country:US
Mailing Address - Phone:410-424-2041
Mailing Address - Fax:410-424-2137
Practice Address - Street 1:216 CRAIN HWY N
Practice Address - Street 2:SUITE 102
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3079
Practice Address - Country:US
Practice Address - Phone:410-424-2041
Practice Address - Fax:410-424-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2973P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health