Provider Demographics
NPI:1093558249
Name:AEGIS COMMUNITY CARE LLC
Entity type:Organization
Organization Name:AEGIS COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:GIKWERERE
Authorized Official - Last Name:MUTATSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-405-9723
Mailing Address - Street 1:1104 PRAIRIEVIEW TER APT E
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7908
Mailing Address - Country:US
Mailing Address - Phone:207-405-9723
Mailing Address - Fax:
Practice Address - Street 1:1104 PRAIRIEVIEW TER APT E
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7908
Practice Address - Country:US
Practice Address - Phone:207-405-9723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities