Provider Demographics
NPI:1639427214
Name:AGILE IN-HOME CARE, L.L.C.
Entity Type:Organization
Organization Name:AGILE IN-HOME CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-805-3974
Mailing Address - Street 1:2804 ROSE ACRES LANE
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1180
Mailing Address - Country:US
Mailing Address - Phone:314-443-7565
Mailing Address - Fax:314-298-3886
Practice Address - Street 1:320 BROOKES DRIVE
Practice Address - Street 2:SUITE 207
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042
Practice Address - Country:US
Practice Address - Phone:314-443-7565
Practice Address - Fax:314-298-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1153679302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization