Provider Demographics
NPI:1215656996
Name:AGATE HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:AGATE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ABBA GANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-766-2778
Mailing Address - Street 1:13410 PARKER COMMONS BLVD STE 103E
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1867
Mailing Address - Country:US
Mailing Address - Phone:239-766-2778
Mailing Address - Fax:239-365-1500
Practice Address - Street 1:13410 PARKER COMMONS BLVD STE 103E
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1867
Practice Address - Country:US
Practice Address - Phone:239-766-2770
Practice Address - Fax:239-365-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health