Provider Demographics
NPI:1619190428
Name:AGC SERVICES
Entity Type:Organization
Organization Name:AGC SERVICES
Other - Org Name:TRI STATE DOMESTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-928-3428
Mailing Address - Street 1:336 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-6323
Mailing Address - Country:US
Mailing Address - Phone:193-928-3428
Mailing Address - Fax:
Practice Address - Street 1:336 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6323
Practice Address - Country:US
Practice Address - Phone:193-928-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00033100251E00000X, 251G00000X, 251J00000X, 251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251G00000XAgenciesHospice Care, Community Based
Not Answered251J00000XAgenciesNursing Care
Not Answered251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ474 8107Medicaid
NJ474 8107Medicaid