Provider Demographics
NPI:1548614597
Name:AGENA HEALTH LLC
Entity Type:Organization
Organization Name:AGENA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NSIKAKABASI
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-514-2177
Mailing Address - Street 1:8712 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1619
Mailing Address - Country:US
Mailing Address - Phone:317-514-2177
Mailing Address - Fax:
Practice Address - Street 1:8712 HIGH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1619
Practice Address - Country:US
Practice Address - Phone:317-514-2177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services