Provider Demographics
NPI:1518484328
Name:AGA HOUSE OF FAITH LLC
Entity Type:Organization
Organization Name:AGA HOUSE OF FAITH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHIMIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-402-2517
Mailing Address - Street 1:9423 BRISTLE BIRD LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2048
Mailing Address - Country:US
Mailing Address - Phone:832-402-2517
Mailing Address - Fax:346-309-2283
Practice Address - Street 1:9423 BRISTLE BIRD LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2048
Practice Address - Country:US
Practice Address - Phone:832-402-2517
Practice Address - Fax:346-309-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child