Healthcare Provider Details

I. General information

NPI: 1841702552
Provider Name (Legal Business Name): AG HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 06/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-1780 28TH AVENUE
KEA'AU HI
96749
US

IV. Provider business mailing address

PO BOX 1243
HILO HI
96721-1243
US

V. Phone/Fax

Practice location:
  • Phone: 808-936-8842
  • Fax:
Mailing address:
  • Phone: 808-936-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOANNA MARIE GALIZA
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 808-936-8842