Provider Demographics
NPI:1609332543
Name:AGESPACE CARE, LLC
Entity Type:Organization
Organization Name:AGESPACE CARE, LLC
Other - Org Name:INTERIM HEALTHCARE HOUSTON SOUTHEAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-798-6166
Mailing Address - Street 1:11550 FUQUA ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4306
Mailing Address - Country:US
Mailing Address - Phone:832-404-2006
Mailing Address - Fax:832-404-2336
Practice Address - Street 1:11550 FUQUA ST
Practice Address - Street 2:SUITE 360
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4306
Practice Address - Country:US
Practice Address - Phone:832-404-2006
Practice Address - Fax:832-404-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care