Provider Demographics
NPI:1780322305
Name:AGBARA HEALTH SERVICES LLC
Entity type:Organization
Organization Name:AGBARA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ERROL
Authorized Official - Last Name:CONYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-268-5689
Mailing Address - Street 1:1420 BARDOT LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3725
Mailing Address - Country:US
Mailing Address - Phone:757-270-4964
Mailing Address - Fax:
Practice Address - Street 1:1420 BARDOT LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3725
Practice Address - Country:US
Practice Address - Phone:757-270-4964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No385H00000XRespite Care FacilityRespite Care