Healthcare Provider Details

I. General information

NPI: 1457505992
Provider Name (Legal Business Name): AGGIE HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN ST STE 7
SMITHFIELD PA
15478-8943
US

IV. Provider business mailing address

25 MAIN ST SUITE # 7
SMITHFIELD PA
15478-8943
US

V. Phone/Fax

Practice location:
  • Phone: 724-569-1889
  • Fax: 724-569-1899
Mailing address:
  • Phone: 724-569-1889
  • Fax: 724-569-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ELMER D SHRADER SR.
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 724-569-1889