Provider Demographics
NPI:1871013920
Name:AGILITY HEALTH
Entity Type:Organization
Organization Name:AGILITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEUKEMA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:650-551-7522
Mailing Address - Street 1:1710 S AMPHLETT BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2704
Mailing Address - Country:US
Mailing Address - Phone:650-453-5100
Mailing Address - Fax:
Practice Address - Street 1:1710 S AMPHLETT BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2704
Practice Address - Country:US
Practice Address - Phone:650-453-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001841251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health