Healthcare Provider Details

I. General information

NPI: 1770145518
Provider Name (Legal Business Name): AGRACE HME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 E CHERYL PKWY
FITCHBURG WI
53711-5395
US

IV. Provider business mailing address

5395 E CHERYL PKWY
FITCHBURG WI
53711-5395
US

V. Phone/Fax

Practice location:
  • Phone: 608-276-4660
  • Fax:
Mailing address:
  • Phone: 608-276-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: LYNNE SEXTEN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 608-327-7190