Healthcare Provider Details

I. General information

NPI: 1114682275
Provider Name (Legal Business Name): AGMB HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 COMMONS DR STE A
MOORESVILLE NC
28117-9262
US

IV. Provider business mailing address

107 COMMONS DR STE A
MOORESVILLE NC
28117-9262
US

V. Phone/Fax

Practice location:
  • Phone: 980-444-6319
  • Fax:
Mailing address:
  • Phone: 980-444-6319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: HELEN RICHARDSON-DAVIS
Title or Position: PRESIDENT / EXECUTIVE DIRECTOR
Credential:
Phone: 980-444-6319