Provider Demographics
NPI:1487314860
Name:AEGIS HOMECARE LLC
Entity type:Organization
Organization Name:AEGIS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINK
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:314-933-4043
Mailing Address - Street 1:2055 CRAIGSHIRE RD
Mailing Address - Street 2:STE 420 F
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-933-4043
Mailing Address - Fax:
Practice Address - Street 1:2055 CRAIGSHIRE RD
Practice Address - Street 2:STE 420 F
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-933-4043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty