Provider Demographics
NPI:1154969590
Name:1ST AGILE HOMECARE LLC
Entity type:Organization
Organization Name:1ST AGILE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROUGUIATOU
Authorized Official - Middle Name:
Authorized Official - Last Name:BAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-802-2685
Mailing Address - Street 1:10911 PEBBLE RUN DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3685
Mailing Address - Country:US
Mailing Address - Phone:301-802-2685
Mailing Address - Fax:
Practice Address - Street 1:10911 PEBBLE RUN DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3685
Practice Address - Country:US
Practice Address - Phone:301-802-2685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health