=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205791266
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGNES HOME HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2025
-----------------------------------------------------
Last Update Date | 12/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5040 ALTHORP PL
-----------------------------------------------------
City | LIBERTY TOWNSHIP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45044-3322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-765-0069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5040 ALTHORP PL
-----------------------------------------------------
City | LIBERTY TOWNSHIP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45044-3322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-765-0069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ERNEST S FOMUNUNG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-765-0069
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------