Provider Demographics
NPI:1578220653
Name:AGAVE HEALTHCARE LLC
Entity Type:Organization
Organization Name:AGAVE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-228-6202
Mailing Address - Street 1:1008 N 1100 E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2066
Mailing Address - Country:US
Mailing Address - Phone:602-855-3500
Mailing Address - Fax:855-930-3500
Practice Address - Street 1:3240 E UNION HILLS DR STE 145
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-2652
Practice Address - Country:US
Practice Address - Phone:602-855-3500
Practice Address - Fax:855-930-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based