Agility Advantage Home Healthcare LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

AGILITY ADVANTAGE HOME HEALTHCARE LLC

Practice address

10339 Quail Cir N
Brooklyn Park, MN 55443-5418

Phone

(612) 212-9212

NPI assigned

Mar 10, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dimitra Tumba Kaulu, LRT, CRT

Title

Owner/Manager

Phone

(612) 212-9212

Specialties & licenses 5

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552176000000",
    "number": "1083172985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10339 QUAIL CIR N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554435418",
            "telephone_number": "612-212-9212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10339 QUAIL CIR N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554435418",
            "telephone_number": "612-212-9212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGILITY ADVANTAGE HOME HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-10",
        "last_updated": "2019-03-10",
        "status": "A",
        "authorized_official_last_name": "KAULU",
        "authorized_official_first_name": "DIMITRA",
        "authorized_official_middle_name": "TUMBA",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "612-212-9212",
        "authorized_official_credential": "LRT, CRT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.