=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598092785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGORA WORLDWIDE UNLIMITED LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2009
-----------------------------------------------------
Last Update Date | 11/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 E CENTENNIAL DR
-----------------------------------------------------
City | OAK CREEK
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53154-8618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-375-8903
-----------------------------------------------------
Fax | 414-375-8904
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 94
-----------------------------------------------------
City | OAK CREEK
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53154-0094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-375-8903
-----------------------------------------------------
Fax | 414-375-8904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | MR. KEITH MARCEL LONDON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-375-8903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 251E00000X
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------