Provider Demographics
NPI:1104983519
Name:AEGIS ASSISTS
Entity type:Organization
Organization Name:AEGIS ASSISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAYETTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-945-2797
Mailing Address - Street 1:1 CLUB HOUSE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-9679
Mailing Address - Country:US
Mailing Address - Phone:302-945-2797
Mailing Address - Fax:302-226-1677
Practice Address - Street 1:1 CLUB HOUSE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-9679
Practice Address - Country:US
Practice Address - Phone:302-945-2797
Practice Address - Fax:302-226-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE06-92052-02-000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health