Healthcare Provider Details

I. General information

NPI: 1073109732
Provider Name (Legal Business Name): AGOO HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W COMMERCIAL BLVD STE 14
FORT LAUDERDALE FL
33309-3320
US

IV. Provider business mailing address

2221 NE 164TH ST STE 296
AVENTURA FL
33160-3703
US

V. Phone/Fax

Practice location:
  • Phone: 888-929-2327
  • Fax:
Mailing address:
  • Phone: 888-929-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WALLACE MAYER DE ROTHSMAN
Title or Position: CEO
Credential:
Phone: 888-929-2327