=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699285312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGILITY HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2017
-----------------------------------------------------
Last Update Date | 10/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 NW LOOP 410 STE 700
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78213-2258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-366-8777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 NW LOOP 410 STE 700
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78213-2258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-366-8777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. MIKE MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-803-8131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------