Provider Demographics
NPI:1992464523
Name:AGAVE THERAPY, LLC
Entity type:Organization
Organization Name:AGAVE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:432-837-5907
Mailing Address - Street 1:610 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-4830
Mailing Address - Country:US
Mailing Address - Phone:432-837-5907
Mailing Address - Fax:866-523-1745
Practice Address - Street 1:610 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-4830
Practice Address - Country:US
Practice Address - Phone:432-837-5907
Practice Address - Fax:866-523-1745
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGAVE HOME HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty