Provider Demographics
NPI:1144648205
Name:ST AGATHA CAREGIVERS INC
Entity type:Organization
Organization Name:ST AGATHA CAREGIVERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:KIWEKWU
Authorized Official - Last Name:AGBOJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-424-2902
Mailing Address - Street 1:6729 SAPPHIRE CIR N
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6283
Mailing Address - Country:US
Mailing Address - Phone:817-424-2902
Mailing Address - Fax:817-251-1963
Practice Address - Street 1:6729 SAPPHIRE CIR N
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6283
Practice Address - Country:US
Practice Address - Phone:817-424-2902
Practice Address - Fax:817-251-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health