=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619556636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE AGENCY HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2021
-----------------------------------------------------
Last Update Date | 09/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 W 41ST ST STE 302
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-363-5051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 78 SW 7TH ST STE 7137
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33130-3402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-363-5051
-----------------------------------------------------
Fax | 305-363-3139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | KARINE GLICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-363-5051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------