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General NPI Number Information
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NPI Number | 1326236373
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Entity Type | Organization
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Legal Business Name | AGILE HOME HEALTH CARE, INC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 5875 N LINCOLN AVE SUITE 126
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City | CHICAGO
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State | IL
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Zip | 60659-4672
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Country | US
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Telephone | 773-506-7450
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Fax | 773-506-7460
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Provider Business Mailing Address
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Address Line | 5875 N LINCOLN AVE SUITE 126
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City | CHICAGO
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State | IL
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Zip | 60659-4672
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Country | US
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Telephone | 773-506-7450
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Fax | 773-506-7460
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Authorized Official
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Title or Position | DON/ADMINISTRATOR
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Name | LEE ANCHETA GASSMANN
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Credential | REGISTERED NURSE
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Telephone | 773-744-5365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1010782
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License Number State | IL
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