Provider Demographics
NPI:1891413795
Name:AGENTS OF HEALING HOMECARE LLC
Entity Type:Organization
Organization Name:AGENTS OF HEALING HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:URAINIUS
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-539-5659
Mailing Address - Street 1:PO BOX 1145
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92402-1145
Mailing Address - Country:US
Mailing Address - Phone:866-414-6632
Mailing Address - Fax:
Practice Address - Street 1:277 BLOOMINGTON AVE UNIT 219
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6494
Practice Address - Country:US
Practice Address - Phone:866-414-6632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care