Provider Demographics
NPI:1285912329
Name:AGENTRIX IN-HOME PROFESSIONAL CARE SERVICE,LLC
Entity type:Organization
Organization Name:AGENTRIX IN-HOME PROFESSIONAL CARE SERVICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-597-2362
Mailing Address - Street 1:2 SERGEANT PRENTISS DR STE A
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4722
Mailing Address - Country:US
Mailing Address - Phone:601-597-2362
Mailing Address - Fax:
Practice Address - Street 1:2 SERGEANT PRENTISS DR STE A
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4722
Practice Address - Country:US
Practice Address - Phone:601-597-2362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12547305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service