Provider Demographics
NPI:1457652935
Name:AGGIES'S PLACE, INC.
Entity Type:Organization
Organization Name:AGGIES'S PLACE, INC.
Other - Org Name:AGATA RUFFIN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGATA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-223-2474
Mailing Address - Street 1:2428 NUREMBERG BLVD.
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-2609
Mailing Address - Country:US
Mailing Address - Phone:941-223-2474
Mailing Address - Fax:941-979-9039
Practice Address - Street 1:2428 NUREMBERG BLVD.
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-2609
Practice Address - Country:US
Practice Address - Phone:941-223-2474
Practice Address - Fax:941-979-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691027196Medicaid